Organization
TEMPORARY LIVING CENTER
Active
Other names
TLC
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. JACQUE LEE ROBINSON-RICHARD (EXECUTIVE DIRECTOR)
(337) 303-3536
Entity
Organization
Contact information
Practice address
7170 BRYANT LAKE DR, EDEN PRAIRIE, MN 55344-3502
(952) 942-6400
Mailing address
7170 BRYANT LAKE DR, EDEN PRAIRIE, MN 55344-3502
(952) 942-6400
Taxonomy
Speciality
Code
Description
License number
State
3245S0500X
Children's Substance Abuse Rehabilitation Facility
Primary
1010423
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2719550000
MN ITS
MN
Enumeration date
05/15/2008
Last updated
05/15/2008
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