Basic Information
| Provider Information | |||||||||
| NPI: | 1588310577 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | TLCS, INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 650 HOWE AVE BLDG 400-A | ||||||||
| Address2: | |||||||||
| City: | SACRAMENTO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 958254731 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9164801801 | ||||||||
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| Practice Location | |||||||||
| Address1: | 650 HOWE AVE BLDG 400-A | ||||||||
| Address2: | |||||||||
| City: | SACRAMENTO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 958254731 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9164801801 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/28/2022 | ||||||||
| LastUpdateDate: | 03/01/2022 | ||||||||
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| AuthorizedOfficialLastName: | JOHANSEN | ||||||||
| AuthorizedOfficialFirstName: | ERIN | ||||||||
| AuthorizedOfficialMiddleName: | K | ||||||||
| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 9164410123 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 03/01/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 171M00000X | Y | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Other Service Providers | Case Manager/Care Coordinator |
No ID Information.