Provider Demographics
NPI:1295248623
Name:TLC GUEST HOME, INC
Entity type:Organization
Organization Name:TLC GUEST HOME, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:MARY ALYN
Authorized Official - Middle Name:ABAD
Authorized Official - Last Name:DOMONDON
Authorized Official - Suffix:
Authorized Official - Credentials:DIRECTOR
Authorized Official - Phone:424-263-5385
Mailing Address - Street 1:733 W CARSON ST
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90502-2106
Mailing Address - Country:US
Mailing Address - Phone:702-502-7632
Mailing Address - Fax:702-359-2388
Practice Address - Street 1:1700 248TH ST
Practice Address - Street 2:
Practice Address - City:LOMITA
Practice Address - State:CA
Practice Address - Zip Code:90717-1333
Practice Address - Country:US
Practice Address - Phone:424-263-5385
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-07
Last Update Date:2017-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility