Tylyce Farms

Primary specialty

Home Health AgencyTaxonomy code 251E00000X

Legal business name

TYLYCE FARMS

Practice address

1937 E 111TH St
Los Angeles, CA 90059-2001

Phone

(661) 797-4018

NPI assigned

Jan 5, 2021

Organization subpart

Yes

Parent organization

MAGENTA SKY PRAs reported in NPPES

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Charde Petrus, DSD

Title

Director

Phone

(661) 797-4018

Specialties & licenses 3

Addresses

Other names 1

• MAGENTA HAZE PR Former legal business name

Part of

Tylyce Farms

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1609804800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1609804800000",
    "number": "1205424405",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3231 KEY LARGO DR APT 202",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891205304",
            "telephone_number": "925-332-8810"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1937 E 111TH ST",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900592001",
            "telephone_number": "661-797-4018"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TYLYCE FARMS",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "MAGENTA SKY PR",
        "enumeration_date": "2021-01-05",
        "last_updated": "2021-01-05",
        "certification_date": "2021-01-04",
        "status": "A",
        "authorized_official_last_name": "PETRUS",
        "authorized_official_first_name": "CHARDE",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "661-797-4018",
        "authorized_official_credential": "DSD"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "167G00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Licensed Psychiatric Technician",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "MAGENTA HAZE PR",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

• Jimmie Lee Tyler
• Maris Anne Tyler
• Shari D Tyler
• Tanya Tyler
• Tiffany Tyler
• Christopher Nicholas Tymchuk, MD
• Tia Tyndal, M.A.
• Maureen Dolan Tyra, LICSW
• Amanda Elizabeth Tyree, M.A.
• Mikol Tyrone

• Home Health Agency in Los Angeles, CA
• Providers in Los Angeles, CA by specialty
• Home Health Agency in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 5, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.