Provider Demographics
NPI: | 1700210440 |
---|---|
Name: | TENDER LOVING CARE ASSISTED LIVING |
Entity Type: | Organization |
Organization Name: | TENDER LOVING CARE ASSISTED LIVING |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | ADMINISTRATOR |
Authorized Official - Prefix: | MS |
Authorized Official - First Name: | SHEILA |
Authorized Official - Middle Name: | LATRICE |
Authorized Official - Last Name: | RHODES |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | MASTERS DEGREE |
Authorized Official - Phone: | 1313-361-5955 |
Mailing Address - Street 1: | 2250 W EUCLID ST |
Mailing Address - Street 2: | |
Mailing Address - City: | DETROIT |
Mailing Address - State: | MI |
Mailing Address - Zip Code: | 48206-2403 |
Mailing Address - Country: | US |
Mailing Address - Phone: | |
Mailing Address - Fax: | |
Practice Address - Street 1: | 2250 W.EUCLID |
Practice Address - Street 2: | |
Practice Address - City: | DETROIT |
Practice Address - State: | MI |
Practice Address - Zip Code: | 48206 |
Practice Address - Country: | US |
Practice Address - Phone: | 131-336-1595 |
Practice Address - Fax: | |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2013-08-29 |
Last Update Date: | 2013-08-29 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
MI | AS820321872 | 311ZA0620X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 311ZA0620X | Nursing & Custodial Care Facilities | Custodial Care Facility | Adult Care Home |