Provider Demographics
NPI:1386942027
Name:AUDREY'S TLC II
Entity type:Organization
Organization Name:AUDREY'S TLC II
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:AUDREY
Authorized Official - Middle Name:BEVERLY
Authorized Official - Last Name:THORPE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:754-368-9993
Mailing Address - Street 1:6808 MERION PL
Mailing Address - Street 2:
Mailing Address - City:N LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33068-3706
Mailing Address - Country:US
Mailing Address - Phone:754-368-9993
Mailing Address - Fax:754-368-9993
Practice Address - Street 1:6808 MERION PL
Practice Address - Street 2:
Practice Address - City:N LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33068-3706
Practice Address - Country:US
Practice Address - Phone:754-368-9993
Practice Address - Fax:754-368-9993
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-04
Last Update Date:2011-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL119433104A0625X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3104A0625XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Mental Illness