Basic Information
| Provider Information | |||||||||
| NPI: | 1922211630 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | TLC MANAGEMENT (DELAWARE VALLEY), LLC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | TLC CHERRY HILL | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 16305 SWINGLEY RIDGE RD | ||||||||
| Address2: | STE. 300 | ||||||||
| City: | CHESTERFIELD | ||||||||
| State: | MO | ||||||||
| PostalCode: | 630171777 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6365342300 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 457 HADDONFIELD RD | ||||||||
| Address2: | SUITE 110 | ||||||||
| City: | CHERRY HILL | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 080022220 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8569109987 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/08/2007 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | ANDREW | ||||||||
| AuthorizedOfficialFirstName: | BRIAN | ||||||||
| AuthorizedOfficialMiddleName: | L. | ||||||||
| AuthorizedOfficialTitleorPosition: | SECRETARY | ||||||||
| AuthorizedOfficialTelephone: | 6365342300 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261Q00000X | Y | Ambulatory Health Care Facilities | Clinic/Center |
No ID Information.