Provider Demographics
NPI:1205230257
Name:MARIA'S TENDER LOVING HOME CARE
Entity Type:Organization
Organization Name:MARIA'S TENDER LOVING HOME CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AGENCY/OWNER
Authorized Official - Prefix:MISS
Authorized Official - First Name:KENYETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:MCCUNE
Authorized Official - Suffix:
Authorized Official - Credentials:HOME HEALTH AIDE
Authorized Official - Phone:313-828-0583
Mailing Address - Street 1:7233 VOERNER AVE
Mailing Address - Street 2:
Mailing Address - City:CENTER LINE
Mailing Address - State:MI
Mailing Address - Zip Code:48015-1810
Mailing Address - Country:US
Mailing Address - Phone:313-828-0583
Mailing Address - Fax:313-372-2794
Practice Address - Street 1:7233 VOERNER AVE
Practice Address - Street 2:
Practice Address - City:CENTER LINE
Practice Address - State:MI
Practice Address - Zip Code:48015-1810
Practice Address - Country:US
Practice Address - Phone:313-828-0583
Practice Address - Fax:313-372-2794
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-20
Last Update Date:2014-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI155482Medicaid