# TLC GP LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** COLONIAL RIDGE NURSING HOME
- **Organization subpart:** No

## Provider details

- **NPI number:** 1225179419
- **Authorized official:** MR. DENNIS DEAPEN (SOLE MANAGER)
- **Authorized official phone:** (214) 773-6000

## Contact information

- **Practice address:** 1901 W ELLIOTT ST, BRECKENRIDGE, TX 76424-4001
- **Practice address phone:** (254) 559-3302
- **Mailing address:** 1901 W ELLIOTT ST, BRECKENRIDGE, TX 76424-4001
- **Mailing address phone:** (254) 559-3302

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 314000000X | Skilled Nursing Facility | — | — | Yes |

## Other

- **Enumeration date:** 02/09/2007
- **Last updated:** 08/22/2020

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 4255 | — | TX |