Provider Demographics
NPI:1053071472
Name:TENDER HEARTS PRP, LLC
Entity Type:Organization
Organization Name:TENDER HEARTS PRP, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ASSISTANT DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:SAMANTHA
Authorized Official - Middle Name:
Authorized Official - Last Name:HAILEY-GRANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:JD
Authorized Official - Phone:301-646-6837
Mailing Address - Street 1:3271 SUDLERSVILLE S
Mailing Address - Street 2:
Mailing Address - City:LAUREL
Mailing Address - State:MD
Mailing Address - Zip Code:20724-2446
Mailing Address - Country:US
Mailing Address - Phone:410-868-0761
Mailing Address - Fax:
Practice Address - Street 1:3450 LAUREL FORT MEADE RD STE 109A
Practice Address - Street 2:
Practice Address - City:LAUREL
Practice Address - State:MD
Practice Address - Zip Code:20724-2040
Practice Address - Country:US
Practice Address - Phone:301-646-6837
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:OPEN HEARTS, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-12-27
Last Update Date:2021-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health