| Organization Name: | TLC HOSPICE |
| NPI Number: | 1558627273 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | DEREK JACOB SQUIRE (OWNER) |
| Mailing Address: | 503 W 2600 S Ste 200 Bountiful |
| State: | UT US |
| Postal Code: | 840107717 |
| Phone Number: | 8012940560 |
| Fax Number: | 8019926590 |
| NPI Enumeration Date: | 04/06/2012 |
| NPI Last Update Date: | 04/12/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 251G00000X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Agencies |
| Taxonomy Classification: | Hospice Care, Community Based |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |