Provider Demographics
NPI:1922349539
Name:TENDER LOVING HOSPITALITY
Entity Type:Organization
Organization Name:TENDER LOVING HOSPITALITY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:DRUCELLA
Authorized Official - Middle Name:DIXON
Authorized Official - Last Name:DEVAUGHN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:354-563-1218
Mailing Address - Street 1:125 NE 9TH AVE
Mailing Address - Street 2:
Mailing Address - City:CRYSTAL RIVER
Mailing Address - State:FL
Mailing Address - Zip Code:34429-4425
Mailing Address - Country:US
Mailing Address - Phone:352-563-1218
Mailing Address - Fax:352-563-0511
Practice Address - Street 1:125 NE 9TH AVE
Practice Address - Street 2:
Practice Address - City:CRYSTAL RIVER
Practice Address - State:FL
Practice Address - Zip Code:34429-4425
Practice Address - Country:US
Practice Address - Phone:352-563-1218
Practice Address - Fax:352-563-0511
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-06
Last Update Date:2013-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL86523104A0625X, 347C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3104A0625XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Mental Illness
No347C00000XTransportation ServicesPrivate Vehicle