Contract Details
Ancillary Care Services
Facility name
TLC Rehab
Provider ID
P000004274
NPI
1326015991
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
20726 West Pennsylvania Avenue
Dunnellon, FL 34431
United States
County
Marion
Phone
3524655880 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Rehabilitation Facility
Map
Address