Provider Demographics
NPI:1467835173
Name:TAND L CARE, LLC
Entity Type:Organization
Organization Name:TAND L CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:MELINDA
Authorized Official - Middle Name:
Authorized Official - Last Name:COOPER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:302-836-8160
Mailing Address - Street 1:1458 MALLARD RD
Mailing Address - Street 2:
Mailing Address - City:GLASSBORO
Mailing Address - State:NJ
Mailing Address - Zip Code:08028-8337
Mailing Address - Country:US
Mailing Address - Phone:888-523-4197
Mailing Address - Fax:
Practice Address - Street 1:1458 MALLARD RD
Practice Address - Street 2:
Practice Address - City:GLASSBORO
Practice Address - State:NJ
Practice Address - Zip Code:08028-8337
Practice Address - Country:US
Practice Address - Phone:888-523-4197
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-30
Last Update Date:2015-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJHP0198200253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ60158975OtherNON-PAR PROVIDER ID NUMBER WITH HORIZON NJ HEALTH INSURANCE