Provider Demographics
NPI:1265975387
Name:TENDER LOVING COMPANION CARE LLC
Entity type:Organization
Organization Name:TENDER LOVING COMPANION CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CNA
Authorized Official - Prefix:
Authorized Official - First Name:TYSNIE
Authorized Official - Middle Name:
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:CNA
Authorized Official - Phone:813-340-0173
Mailing Address - Street 1:13104 SANCTUARY COVE DR
Mailing Address - Street 2:UNIT 104
Mailing Address - City:TEMPLE TERRACE
Mailing Address - State:FL
Mailing Address - Zip Code:33637-2161
Mailing Address - Country:US
Mailing Address - Phone:813-340-0173
Mailing Address - Fax:
Practice Address - Street 1:13104 SANCTUARY COVE DR
Practice Address - Street 2:UNIT 104
Practice Address - City:TEMPLE TERRACE
Practice Address - State:FL
Practice Address - Zip Code:33637-2161
Practice Address - Country:US
Practice Address - Phone:813-340-0173
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-21
Last Update Date:2016-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCNA307360311ZA0620X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home