Contract Details
Ancillary Care Services
Facility name
TLC Rehab
Provider ID
P000003963
NPI
1174832265
Tax ID
650443469
Effective Date
4/1/2012
Last Updated
10/2/2013
Direct Contract
No
Status
Active
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
92.00
Location Details
Address
810 East Bell Vista Street
Lakeland, FL 33805
United States
County
Polk
Phone
8636889993 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Rehabilitation Facility
Map
Address