Organization
TLC PROVIDERS INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. TERRY WAYNE BOOKER (OWNER/OPERATOR)
(850) 236-0073
Entity
Organization
Contact information
Practice address
8317 FRONT BEACH RD, SUITE 29A1, PANAMA CITY BEACH, FL 32407-4885
(850) 236-0073
(850) 236-0403
Mailing address
8317 FRONT BEACH RD, SUITE 29A1, PANAMA CITY BEACH, FL 32407-4885
(850) 236-0073
(850) 236-0403
Taxonomy
Speciality
Code
Description
License number
State
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
—
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
679970196
—
FL
05
—
679970198
—
FL
Enumeration date
01/03/2011
Last updated
01/03/2011
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