NPIMap

Organization Active NPI

TLC Nursing Services of Roseville Inc

  • Home Health Agency
  • Saint Paul, MN
National Provider Identifier
1720065600
Registry record updated Sep 17, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Home Health AgencyTaxonomy code 251E00000X
Legal business name
TLC NURSING SERVICES OF ROSEVILLE INC
Practice address
1919 University Ave W Ste 130
Saint Paul, MN 55104-3492
Phone
(651) 647-0017
Fax
(651) 647-3423
NPI assigned
Dec 30, 2005
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 17, 2015

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

Authorized official

Name
Solomon NMN Mulugeta
Title
Ceo
Phone
(818) 823-1000

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Home Health Agency 251E00000X Primary

Addresses

Primary practice location

1919 University Ave W Ste 130
Saint Paul, MN 55104-3492

Mailing address

1919 University Ave W Ste 130
Saint Paul, MN 55104-3492
Phone (651) 647-0017

Other identifiers 1

IdentifierTypeStateIssuer
040518300MedicaidMN

Other names 1

  • TLC Home Care of the Twin Cities Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MN

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20100310000128 MN Part A Provider - Home Health Agency 2769527126 Practice locations: Saint Paul, MN

Home health agency certification: CCN 248030

Legal name
TLC NURSING SERVICES OF ROSEVILLE, INC.
Doing business as
TLC HOME CARE OF THE TWIN CITIES
Certification status
Active
Provider type (POS)
Home health agency
Participating since
Sep 28, 1995
Last certification
Feb 27, 2020
Ownership / control type
Proprietary
Organization structure
CorporationProprietary
Incorporated
Jan 1, 1988 in MN
Enrollment address
1919 University Ave W
Ste 130
Saint Paul, MN 55104-3492
HHA Branch

Care Compare: Home health agency

Medicare Care Compare
Listed as
TLC Home Care of the Twin CitiesCCN 248030
Ownership
Proprietary
Certified
Sep 28, 1995
Medicare certification status
ActiveFrom the Provider of Services file
Services
Nursing, Home health aide, Physical therapy, Occupational therapy

National Provider Directory

National Provider Directory

Locations

1255 Larpenteur Ave W
Saint Paul, MN 55113
Phone (651) 647-0017

1919 University Ave W
Ste 130
Saint Paul, MN 55104
Phone (651) 647-0017

Ownership & related parties

All disclosed owners & managing parties 2

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Bethlehem Mulugeta Individual Operational/Managerial ControlAdministrator Nov 2, 2019 100%
Solomon Mulugeta Individual 5% Or Greater Direct Ownership Interest Jan 1, 1988 100%
Corporate Officer Jan 1, 1988
Corporate Director Jan 1, 1988 100%
W-2 Managing EmployeeAdministrator Nov 1, 2018

Practitioners & affiliated clinicians

Practitioners 11

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1135900800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1442448000000",
    "number": "1720065600",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1919 UNIVERSITY AVE W STE 130",
            "city": "SAINT PAUL",
            "state": "MN",
            "postal_code": "551043492",
            "telephone_number": "651-647-0017",
            "fax_number": "651-647-3423"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1919 UNIVERSITY AVE W STE 130",
            "city": "SAINT PAUL",
            "state": "MN",
            "postal_code": "551043492",
            "telephone_number": "651-647-0017",
            "fax_number": "651-647-3423"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TLC NURSING SERVICES OF ROSEVILLE INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-12-30",
        "last_updated": "2015-09-17",
        "status": "A",
        "authorized_official_last_name": "MULUGETA",
        "authorized_official_first_name": "SOLOMON",
        "authorized_official_middle_name": "NMN",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "818-823-1000"
    },
    "taxonomies": [
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "040518300",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "TLC Home Care of the Twin Cities",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Saint Paul, MN

Sources for this page

Verify at the official NPI Registry.