Provider Demographics
NPI:1720154941
Name:TERESA K PARKER
Entity Type:Organization
Organization Name:TERESA K PARKER
Other - Org Name:TLC HOME
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:TERESA
Authorized Official - Middle Name:KAY
Authorized Official - Last Name:PARKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:573-814-0823
Mailing Address - Street 1:2650 N LAKELAND DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65202-6972
Mailing Address - Country:US
Mailing Address - Phone:573-814-0823
Mailing Address - Fax:573-814-2863
Practice Address - Street 1:2650 N LAKELAND DR
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65202-6972
Practice Address - Country:US
Practice Address - Phone:573-814-0823
Practice Address - Fax:573-814-2863
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-28
Last Update Date:2008-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO7164529320600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities