Provider Demographics
NPI:1467744169
Name:TENDER LOVING CARE SERVICES CORP
Entity Type:Organization
Organization Name:TENDER LOVING CARE SERVICES CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:STACI
Authorized Official - Middle Name:
Authorized Official - Last Name:RICHARDSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:850-223-1936
Mailing Address - Street 1:115 W GREEN ST
Mailing Address - Street 2:SUITE 204
Mailing Address - City:PERRY
Mailing Address - State:FL
Mailing Address - Zip Code:32347-3226
Mailing Address - Country:US
Mailing Address - Phone:850-223-1936
Mailing Address - Fax:
Practice Address - Street 1:115 W GREEN ST
Practice Address - Street 2:SUITE 204
Practice Address - City:PERRY
Practice Address - State:FL
Practice Address - Zip Code:32347-3226
Practice Address - Country:US
Practice Address - Phone:850-223-1936
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-12
Last Update Date:2011-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL14815253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL688271496Medicaid
FL688271498Medicaid