Provider Demographics
NPI:1417226374
Name:TENDER TOUCH OF CLEVELAND
Entity Type:Organization
Organization Name:TENDER TOUCH OF CLEVELAND
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JANICE
Authorized Official - Middle Name:DENICE
Authorized Official - Last Name:PETTIES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:440-341-7309
Mailing Address - Street 1:5035 EDSAL DR
Mailing Address - Street 2:
Mailing Address - City:LYNDHURST
Mailing Address - State:OH
Mailing Address - Zip Code:44124-2306
Mailing Address - Country:US
Mailing Address - Phone:440-341-7309
Mailing Address - Fax:
Practice Address - Street 1:5035 EDSAL DR
Practice Address - Street 2:
Practice Address - City:LYNDHURST
Practice Address - State:OH
Practice Address - Zip Code:44124-2306
Practice Address - Country:US
Practice Address - Phone:440-341-7309
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TENDER TOUCH OF CLEVELAND
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-12-22
Last Update Date:2011-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH400300631103163WH0200X, 164X00000X, 372500000X, 3747A0650X, 3747P1801X, 376J00000X
OHRS000497172A00000X
OH40003000631103372600000X
376G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes164X00000XNursing Service ProvidersLicensed Vocational NurseGroup - Single Specialty
No163WH0200XNursing Service ProvidersRegistered NurseHome HealthGroup - Single Specialty
No172A00000XOther Service ProvidersDriverGroup - Single Specialty
No372500000XNursing Service Related ProvidersChore ProviderGroup - Single Specialty
No372600000XNursing Service Related ProvidersAdult CompanionGroup - Single Specialty
No3747A0650XNursing Service Related ProvidersTechnicianAttendant Care ProviderGroup - Single Specialty
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care AttendantGroup - Single Specialty
No376G00000XNursing Service Related ProvidersNursing Home AdministratorGroup - Single Specialty
No376J00000XNursing Service Related ProvidersHomemakerGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH=========Medicaid