Provider Demographics
NPI:1598181471
Name:YOUR TENDER LOVING CARE LLC
Entity Type:Organization
Organization Name:YOUR TENDER LOVING CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:JACQUELYNE
Authorized Official - Middle Name:
Authorized Official - Last Name:BODLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-802-8080
Mailing Address - Street 1:625 N EUCLID AVE STE 551B
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63108-1690
Mailing Address - Country:US
Mailing Address - Phone:314-802-8080
Mailing Address - Fax:314-802-8082
Practice Address - Street 1:625 N EUCLID AVE STE 551B
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63108-1690
Practice Address - Country:US
Practice Address - Phone:314-802-8080
Practice Address - Fax:314-802-8082
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-14
Last Update Date:2014-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care