Provider Demographics
NPI:1629018999
Name:TENDER LOVING CARE HEALTH CARE SERVICES SOUTHEAST, LLC
Entity Type:Organization
Organization Name:TENDER LOVING CARE HEALTH CARE SERVICES SOUTHEAST, LLC
Other - Org Name:AMEDISYS HOME CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:KUSSEROW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:225-292-2031
Mailing Address - Street 1:3854 AMERICAN WAY
Mailing Address - Street 2:SUITE A
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70816-4013
Mailing Address - Country:US
Mailing Address - Phone:225-292-2031
Mailing Address - Fax:225-295-9678
Practice Address - Street 1:8245 TOURNAMENT DR
Practice Address - Street 2:SUITE 255
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38125-8898
Practice Address - Country:US
Practice Address - Phone:901-748-9121
Practice Address - Fax:901-748-9125
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TLC HEALTH CARE SERVICES, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-06-07
Last Update Date:2016-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000000239251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN201031840002OtherTRICARE HUMANA PPS
TN4103402OtherTN BCBS OF TN
TN447538OtherHUMANA GOLD CHOICE PPS
TN447538OtherHUMANA GOLD CHOICE PPS