Organization
TLC GROUP CHOICE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KIROS TESFAYE (BUSINESS MANAGER)
(657) 647-0017
Entity
Organization
Contact information
Practice address
1255 LARPENTEUR AVE W, SAINT PAUL, MN 55113-6337
(651) 647-0017
Mailing address
1255 LARPENTEUR AVE W, SAINT PAUL, MN 55113-6337
(651) 647-0017
Taxonomy
Speciality
Code
Description
License number
State
313M00000X
Nursing Facility/Intermediate Care Facility
Primary
—
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
7009329
MN STATE ID NUMBER
MN
Enumeration date
03/13/2007
Last updated
08/22/2020
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