Provider Demographics
NPI:1275908360
Name:TENDER LOVING CARE
Entity Type:Organization
Organization Name:TENDER LOVING CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DON
Authorized Official - Prefix:
Authorized Official - First Name:SHAMEEKA
Authorized Official - Middle Name:
Authorized Official - Last Name:KELLY
Authorized Official - Suffix:
Authorized Official - Credentials:PN
Authorized Official - Phone:731-343-8684
Mailing Address - Street 1:3540 SUMMER AVE
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38122-3600
Mailing Address - Country:US
Mailing Address - Phone:901-324-6337
Mailing Address - Fax:901-567-5801
Practice Address - Street 1:3540 SUMMER AVE
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38122-3600
Practice Address - Country:US
Practice Address - Phone:901-324-6337
Practice Address - Fax:901-567-5801
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-01
Last Update Date:2015-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN11445892Medicaid