Provider Demographics
NPI:1821093162
Name:TENDERCARE HOME HEALTH SERVICES, INC.
Entity Type:Organization
Organization Name:TENDERCARE HOME HEALTH SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:LESLIE
Authorized Official - Middle Name:
Authorized Official - Last Name:DEITCHMAN
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:317-251-0700
Mailing Address - Street 1:6308 RUCKER RD
Mailing Address - Street 2:STE D
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46220-4881
Mailing Address - Country:US
Mailing Address - Phone:317-251-0700
Mailing Address - Fax:317-251-7440
Practice Address - Street 1:6308 RUCKER RD
Practice Address - Street 2:STE D
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46220-4881
Practice Address - Country:US
Practice Address - Phone:317-251-0700
Practice Address - Fax:317-251-7440
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-14
Last Update Date:2010-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN40-007519-1251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100389750AMedicaid
IN157401Medicare ID - Type Unspecified