Provider Demographics
NPI:1508016387
Name:TENDER CARE MEDICAL SERVICES, INC.
Entity Type:Organization
Organization Name:TENDER CARE MEDICAL SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:LORI
Authorized Official - Middle Name:
Authorized Official - Last Name:MAZZUCO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:352-683-6831
Mailing Address - Street 1:PO BOX 5159
Mailing Address - Street 2:
Mailing Address - City:SPRING HILL
Mailing Address - State:FL
Mailing Address - Zip Code:34611-5159
Mailing Address - Country:US
Mailing Address - Phone:352-683-6831
Mailing Address - Fax:352-666-3200
Practice Address - Street 1:306 BEVERLY CT
Practice Address - Street 2:
Practice Address - City:SPRING HILL
Practice Address - State:FL
Practice Address - Zip Code:34606-5326
Practice Address - Country:US
Practice Address - Phone:352-683-6831
Practice Address - Fax:352-666-3200
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-29
Last Update Date:2012-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL60080988261QM3000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM3000XAmbulatory Health Care FacilitiesClinic/CenterMedically Fragile Infants and Children Day Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL000179900Medicaid