Provider Demographics
NPI:1679751374
Name:TENDER CARE PEDIATRIC SERVICES, INC
Entity Type:Organization
Organization Name:TENDER CARE PEDIATRIC SERVICES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:HOGFELDT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:970-686-5437
Mailing Address - Street 1:3800 AUTOMATION WAY STE 200
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80525-3451
Mailing Address - Country:US
Mailing Address - Phone:970-686-5437
Mailing Address - Fax:970-686-6016
Practice Address - Street 1:5677 BOEING DR
Practice Address - Street 2:
Practice Address - City:LOVELAND
Practice Address - State:CO
Practice Address - Zip Code:80538-8811
Practice Address - Country:US
Practice Address - Phone:970-686-5437
Practice Address - Fax:970-686-6016
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-05
Last Update Date:2022-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO58980881Medicaid
CO067463Medicare PIN