Provider Demographics
NPI:1033653357
Name:TENDER HEARTS HOMECARE
Entity Type:Organization
Organization Name:TENDER HEARTS HOMECARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TYNESHIA
Authorized Official - Middle Name:
Authorized Official - Last Name:JACKSON
Authorized Official - Suffix:
Authorized Official - Credentials:LPN
Authorized Official - Phone:601-408-2934
Mailing Address - Street 1:2436 BEACH BLVD
Mailing Address - Street 2:#A8
Mailing Address - City:BILOXI
Mailing Address - State:MS
Mailing Address - Zip Code:39531-4910
Mailing Address - Country:US
Mailing Address - Phone:601-408-2934
Mailing Address - Fax:
Practice Address - Street 1:2436 BEACH BLVD
Practice Address - Street 2:#A8
Practice Address - City:BILOXI
Practice Address - State:MS
Practice Address - Zip Code:39531-4910
Practice Address - Country:US
Practice Address - Phone:601-408-2934
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-05
Last Update Date:2016-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS1104877251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management