Provider Demographics
NPI:1235182767
Name:TENDER LOVING CARE HEALTH CARE SERVICES OF GEORGIA, LLC
Entity Type:Organization
Organization Name:TENDER LOVING CARE HEALTH CARE SERVICES OF GEORGIA, LLC
Other - Org Name:STAFF BUILDERS HOME HEALTH, AN AMEDISYS COMPANY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DELEGATED OFFICIAL
Authorized Official - Prefix:MS
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:U
Authorized Official - Last Name:GOFF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:225-299-3701
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:225-299-3701
Mailing Address - Fax:225-295-9678
Practice Address - Street 1:3505 DULUTH PARK LN
Practice Address - Street 2:SUITE 300
Practice Address - City:DULUTH
Practice Address - State:GA
Practice Address - Zip Code:30096-3201
Practice Address - Country:US
Practice Address - Phone:678-417-1033
Practice Address - Fax:770-622-9870
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-18
Last Update Date:2019-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA060286251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003124560AMedicaid
GA117083OtherTENET CHOICES PPS
GA117083OtherHUMANA PPS
GA000281905AMedicaid
GA000281905HMedicaid
GA000281905HMedicaid