Provider Demographics
NPI:1760246540
Name:TENDER LOVING CARE HOME AGENCY LLC
Entity Type:Organization
Organization Name:TENDER LOVING CARE HOME AGENCY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:TAMCIKO
Authorized Official - Middle Name:
Authorized Official - Last Name:BRODUS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:863-812-6402
Mailing Address - Street 1:350 24TH ST NW APT M107
Mailing Address - Street 2:
Mailing Address - City:WINTER HAVEN
Mailing Address - State:FL
Mailing Address - Zip Code:33880-7223
Mailing Address - Country:US
Mailing Address - Phone:863-812-6402
Mailing Address - Fax:
Practice Address - Street 1:350 24TH ST NW APT M107
Practice Address - Street 2:
Practice Address - City:WINTER HAVEN
Practice Address - State:FL
Practice Address - Zip Code:33880-7223
Practice Address - Country:US
Practice Address - Phone:863-812-6402
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-12
Last Update Date:2024-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services