Provider Demographics
NPI:1578101465
Name:TENDERCARE
Entity Type:Organization
Organization Name:TENDERCARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GRACIOUS
Authorized Official - Middle Name:
Authorized Official - Last Name:WEAH
Authorized Official - Suffix:
Authorized Official - Credentials:CNA-DT
Authorized Official - Phone:433-565-2619
Mailing Address - Street 1:8603 GRAY FOX RD APT 203
Mailing Address - Street 2:
Mailing Address - City:RANDALLSTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21133-5145
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8603 GRAY FOX RD APT 203
Practice Address - Street 2:
Practice Address - City:RANDALLSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21133-5145
Practice Address - Country:US
Practice Address - Phone:443-565-2619
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-12-11
Last Update Date:2019-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care AttendantGroup - Single Specialty