Provider Demographics
NPI:1093769226
Name:TENDER LOVING CARE HEALTH CARE SERVICES WESTERN, LLC
Entity Type:Organization
Organization Name:TENDER LOVING CARE HEALTH CARE SERVICES WESTERN, LLC
Other - Org Name:TENDER LOVING CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:WILLARD
Authorized Official - Middle Name:T
Authorized Official - Last Name:DERR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:516-358-1000
Mailing Address - Street 1:1983 MARCUS AVE
Mailing Address - Street 2:STE 200
Mailing Address - City:LAKE SUCCESS
Mailing Address - State:NY
Mailing Address - Zip Code:11042-1016
Mailing Address - Country:US
Mailing Address - Phone:516-358-1000
Mailing Address - Fax:516-327-8636
Practice Address - Street 1:2111 N NORTHGATE WAY
Practice Address - Street 2:STE 103
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98133-9018
Practice Address - Country:US
Practice Address - Phone:206-729-3900
Practice Address - Fax:206-729-6125
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TLC HEALTH CARE SERVICES, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-05-20
Last Update Date:2007-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAIS-449251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA9056953Medicaid
WA9056953Medicaid