Provider Demographics
NPI:1215220256
Name:TATIANA'S HOME CARE, LLC
Entity Type:Organization
Organization Name:TATIANA'S HOME CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER / OPERATOR
Authorized Official - Prefix:DR
Authorized Official - First Name:TATIANA
Authorized Official - Middle Name:
Authorized Official - Last Name:GAVALCINOVA
Authorized Official - Suffix:
Authorized Official - Credentials:DR
Authorized Official - Phone:937-426-4579
Mailing Address - Street 1:2378 HEATHER GLEN CT
Mailing Address - Street 2:P.O. BOX 340156 BEAVERCREEK, OH 45434
Mailing Address - City:BEAVERCREEK
Mailing Address - State:OH
Mailing Address - Zip Code:45431-5620
Mailing Address - Country:US
Mailing Address - Phone:937-426-4579
Mailing Address - Fax:937-426-4883
Practice Address - Street 1:2378 HEATHER GLEN CT
Practice Address - Street 2:
Practice Address - City:BEAVERCREEK
Practice Address - State:OH
Practice Address - Zip Code:45431-5620
Practice Address - Country:US
Practice Address - Phone:937-241-4417
Practice Address - Fax:937-426-4883
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-24
Last Update Date:2011-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320700000XResidential Treatment FacilitiesResidential Treatment Facility, Physical Disabilities