Provider Demographics
NPI:1902178775
Name:TENDER CARE MEDICAL SERVICES OF ST. JOHNS COUNTY, INC.
Entity Type:Organization
Organization Name:TENDER CARE MEDICAL SERVICES OF ST. JOHNS COUNTY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:PHYLLIS
Authorized Official - Middle Name:
Authorized Official - Last Name:MIDDLETON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:904-217-7648
Mailing Address - Street 1:910 S WINTERHAWK DR
Mailing Address - Street 2:SUITE 101
Mailing Address - City:ST AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32086-3870
Mailing Address - Country:US
Mailing Address - Phone:904-217-7648
Mailing Address - Fax:352-666-3232
Practice Address - Street 1:910 S WINTERHAWK DR
Practice Address - Street 2:SUITE 101
Practice Address - City:ST AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32086-3870
Practice Address - Country:US
Practice Address - Phone:904-217-7648
Practice Address - Fax:352-666-3232
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-08
Last Update Date:2012-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM3000XAmbulatory Health Care FacilitiesClinic/CenterMedically Fragile Infants and Children Day Care