Provider Demographics
NPI:1013961267
Name:TENDER LOVING CARE HEALTH CARE SERVICES WESTERN, LLC
Entity Type:Organization
Organization Name:TENDER LOVING CARE HEALTH CARE SERVICES WESTERN, LLC
Other - Org Name:AMEDISYS HOME HEALTH CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP TAX
Authorized Official - Prefix:
Authorized Official - First Name:TRAVIS
Authorized Official - Middle Name:
Authorized Official - Last Name:MIGLICCO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:225-299-3803
Mailing Address - Street 1:3854 AMERICAN WAY
Mailing Address - Street 2:SUITE A
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70816-4013
Mailing Address - Country:US
Mailing Address - Phone:225-292-2031
Mailing Address - Fax:225-295-9678
Practice Address - Street 1:645 E MISSOURI AVE STE 265
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85012-0005
Practice Address - Country:US
Practice Address - Phone:602-200-0835
Practice Address - Fax:602-200-8465
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-20
Last Update Date:2024-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZHHA3720251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ037106OtherGROUP HEALTH COOPERATIVE
AZ958879OtherARIZONA PHYSICIAN IPA
AZ037106OtherHUMANA PPS
AZ958879Medicaid
AZ037106OtherSECURE HORIZONS DIRECT PP
AZ037106Medicare Oscar/Certification