Provider Demographics
NPI:1720065600
Name:TLC NURSING SERVICES OF ROSEVILLE INC
Entity Type:Organization
Organization Name:TLC NURSING SERVICES OF ROSEVILLE INC
Other - Org Name:TLC HOME CARE OF THE TWIN CITIES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:SOLOMON
Authorized Official - Middle Name:NMN
Authorized Official - Last Name:MULUGETA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-823-1000
Mailing Address - Street 1:1919 UNIVERSITY AVE W STE 130
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55104-3492
Mailing Address - Country:US
Mailing Address - Phone:651-647-0017
Mailing Address - Fax:651-647-3423
Practice Address - Street 1:1919 UNIVERSITY AVE W STE 130
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55104-3492
Practice Address - Country:US
Practice Address - Phone:651-647-0017
Practice Address - Fax:651-647-3423
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-30
Last Update Date:2015-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN040518300Medicaid
MN248030Medicare PIN