| Tlc Adult Group Home | |
|
210 Soundward Ln Hertford NC 27944-9749 | |
| (252) 813-5557 | |
| Not Available |
| Full Name | Tlc Adult Group Home |
|---|---|
| Speciality | Custodial Care Facility - Adult Care Home |
| Location | 210 Soundward Ln, Hertford, North Carolina |
| Authorized Official Name and Position | Karen Denise Clarke (OWNER) |
| Authorized Official Contact | 2524263496 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Tlc Adult Group Home 210 Soundward Ln Hertford NC 27944-9749 Ph: (252) 813-5557 | Tlc Adult Group Home 210 Soundward Ln Hertford NC 27944-9749 Ph: (252) 813-5557 |
| NPI Number | 1801121140 |
|---|---|
| Provider Enumeration Date | 10/05/2009 |
| Last Update Date | 12/15/2023 |
| Certification Date | 12/15/2023 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1801121140 | NPI | - | NPPES |
| MHL-072-008 | Other | NC | MENTAL HEALTH STATE LICENSE NUMBER |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0850X | Clinic/center - Adult Mental Health | MHL-072-008 (North Carolina) | Secondary |
| 311ZA0620X | Custodial Care Facility - Adult Care Home | (* (Not Available)) | Primary |
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