# ODOMS TLC HOMECARE SERVICE

> Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days. [Update your NPPES record](https://nppes.cms.hhs.gov)

- **Entity:** Organization
- **Status:** Active
- **Other names:** ODOMS TLC HOMECARE SERVICE
- **Organization subpart:** No

## Provider details

- **NPI number:** 1063045094
- **Authorized official:** LOLITA BURNNETT ELLIS (MEDICAID PROVIDER)
- **Authorized official phone:** (904) 362-2487

## Contact information

- **Practice address:** 1600 LANSDOWNE DR APT 609, JACKSONVILLE, FL 32211-9010
- **Practice address phone:** (904) 362-2487
- **Mailing address:** 1600 LANSDOWNE DR APT 609, JACKSONVILLE, FL 32211-9010
- **Mailing address phone:** (904) 362-2487

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 376K00000X | Nurse's Aide | — | NULL | Yes |
| 376K00000X | Nurse's Aide | — | — | Yes |

## Other

- **Enumeration date:** 02/18/2020
- **Last updated:** 02/18/2020

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 024241200 | — | FL |
| 05 | — | 10179500 | — | FL |