Provider Demographics
NPI:1053480509
Name:TENDER LOVE PCA SERVICES LLC
Entity Type:Organization
Organization Name:TENDER LOVE PCA SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:NORA
Authorized Official - Middle Name:LYNETTY
Authorized Official - Last Name:COSSETT
Authorized Official - Suffix:
Authorized Official - Credentials:LPN
Authorized Official - Phone:225-775-6011
Mailing Address - Street 1:4686 GROOM RD STE D
Mailing Address - Street 2:
Mailing Address - City:BAKER
Mailing Address - State:LA
Mailing Address - Zip Code:70714-3049
Mailing Address - Country:US
Mailing Address - Phone:225-775-6011
Mailing Address - Fax:225-775-6078
Practice Address - Street 1:4686 GROOM RD STE D
Practice Address - Street 2:
Practice Address - City:BAKER
Practice Address - State:LA
Practice Address - Zip Code:70714-3049
Practice Address - Country:US
Practice Address - Phone:225-775-6011
Practice Address - Fax:225-775-6078
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA12245251C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1624098Medicaid