Provider Demographics
NPI:1578521258
Name:TENDER HEART HOME HEALTH, LLC
Entity Type:Organization
Organization Name:TENDER HEART HOME HEALTH, LLC
Other - Org Name:TENDER HEART HOME HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:KOFO
Authorized Official - Middle Name:KAY
Authorized Official - Last Name:SERIKI
Authorized Official - Suffix:
Authorized Official - Credentials:MPA
Authorized Official - Phone:817-265-0066
Mailing Address - Street 1:3210 W PARK ROW DR
Mailing Address - Street 2:
Mailing Address - City:PANTEGO
Mailing Address - State:TX
Mailing Address - Zip Code:76013-3153
Mailing Address - Country:US
Mailing Address - Phone:817-265-0066
Mailing Address - Fax:817-265-0089
Practice Address - Street 1:3210 W PARK ROW DR
Practice Address - Street 2:
Practice Address - City:PANTEGO
Practice Address - State:TX
Practice Address - Zip Code:76013-3136
Practice Address - Country:US
Practice Address - Phone:817-265-0066
Practice Address - Fax:817-265-0089
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-03
Last Update Date:2012-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX005005251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX024294301Medicaid
TX459213Medicare ID - Type Unspecified