Provider Demographics
NPI:1043479611
Name:TENDER CARE SERVICES, LLC
Entity Type:Organization
Organization Name:TENDER CARE SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARY
Authorized Official - Middle Name:A
Authorized Official - Last Name:FAYOMI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-343-2592
Mailing Address - Street 1:1166 HUNTERS DR
Mailing Address - Street 2:
Mailing Address - City:STONE MOUNTAIN
Mailing Address - State:GA
Mailing Address - Zip Code:30083-2552
Mailing Address - Country:US
Mailing Address - Phone:404-343-2592
Mailing Address - Fax:404-920-8188
Practice Address - Street 1:1166 HUNTERS DR
Practice Address - Street 2:
Practice Address - City:STONE MOUNTAIN
Practice Address - State:GA
Practice Address - Zip Code:30083-2552
Practice Address - Country:US
Practice Address - Phone:404-343-2592
Practice Address - Fax:404-920-8188
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-08
Last Update Date:2011-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA044-R-0462251J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA162642967AMedicaid