Organization
TEACHING LIVING CONCEPTS INC
Active
Other names
TLC on Lombard
Organization subpart
No
Provider details
NPI number
Authorized official
DR. VELVET PEREZ (PRESIDENT CEO)
(707) 571-1858
Entity
Organization
Contact information
Practice address
804 LOMBARD WAY, ROHNERT PARK, CA 94928-4504
(707) 795-1715
(707) 664-1356
Mailing address
840 MARK WEST SPRINGS RD, SANTA ROSA, CA 95404-1140
(707) 571-1858
(707) 571-1858
Taxonomy
Speciality
Code
Description
License number
State
315P00000X
Intellectual Disabilities Intermediate Care Facility
Primary
—
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
55G384
STATE PROVIDER ID
CA
01
—
LTC60976G
MEDI-CAL PROVIDER ID
CA
Enumeration date
02/27/2007
Last updated
08/22/2020
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