Provider Demographics
NPI:1629382270
Name:TENDER LOVING CARE MEDICAL SOCIAL WORKER AGENCY, INC.
Entity Type:Organization
Organization Name:TENDER LOVING CARE MEDICAL SOCIAL WORKER AGENCY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MS
Authorized Official - First Name:YVETTE
Authorized Official - Middle Name:ANTOINETTE
Authorized Official - Last Name:JACKSON
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:323-253-9780
Mailing Address - Street 1:400 CORPORATE POINTE
Mailing Address - Street 2:SUITE 300
Mailing Address - City:CULVER CITY
Mailing Address - State:CA
Mailing Address - Zip Code:90230-7615
Mailing Address - Country:US
Mailing Address - Phone:424-750-3133
Mailing Address - Fax:424-750-3135
Practice Address - Street 1:400 CORPORATE POINTE
Practice Address - Street 2:SUITE 300
Practice Address - City:CULVER CITY
Practice Address - State:CA
Practice Address - Zip Code:90230-7615
Practice Address - Country:US
Practice Address - Phone:424-750-3133
Practice Address - Fax:424-750-3135
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-05
Last Update Date:2016-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA65069251B00000X, 251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No251B00000XAgenciesCase Management