Provider Demographics
NPI:1083669873
Name:TENDER LOVING CARE HEALTH CARE SERVICES SOUTHEAST, LLC
Entity Type:Organization
Organization Name:TENDER LOVING CARE HEALTH CARE SERVICES SOUTHEAST, LLC
Other - Org Name:AMEDISYS HOME HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SR VP TAX
Authorized Official - Prefix:
Authorized Official - First Name:TRAVIS
Authorized Official - Middle Name:
Authorized Official - Last Name:MIGLICCO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:225-299-3803
Mailing Address - Street 1:3854 AMERICAN WAY STE A
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70816-4897
Mailing Address - Country:US
Mailing Address - Phone:225-292-2031
Mailing Address - Fax:225-295-9678
Practice Address - Street 1:1005 SLATER RD
Practice Address - Street 2:SUITE 105
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27703-8448
Practice Address - Country:US
Practice Address - Phone:919-941-5793
Practice Address - Fax:919-941-9012
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-23
Last Update Date:2023-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCHC0145251E00000X
NCHC0134251E00000X
NCHC0078251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0000AOtherNC BCBS
NC201031840020OtherTRICARE
NC3427110Medicaid
NC1083669873Medicaid
NC347110OtherSECURE HORIZON
NC201031840020OtherTRICARE