Provider Demographics
NPI:1174282016
Name:TENDER HEARTS LLC
Entity Type:Organization
Organization Name:TENDER HEARTS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/THERAPIST
Authorized Official - Prefix:MS
Authorized Official - First Name:ROQUEL
Authorized Official - Middle Name:
Authorized Official - Last Name:LABATAD
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:505-203-5414
Mailing Address - Street 1:PO BOX 352
Mailing Address - Street 2:
Mailing Address - City:GUADALUPITA
Mailing Address - State:NM
Mailing Address - Zip Code:87722-0352
Mailing Address - Country:US
Mailing Address - Phone:505-203-5414
Mailing Address - Fax:575-387-6431
Practice Address - Street 1:1272B HWY 434
Practice Address - Street 2:
Practice Address - City:GUADALUPITA
Practice Address - State:NM
Practice Address - Zip Code:87722
Practice Address - Country:US
Practice Address - Phone:505-203-5414
Practice Address - Fax:575-387-6431
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-08
Last Update Date:2021-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM57186324Medicaid