Provider Demographics
NPI:1295086601
Name:TENDER HEART HOME CARE
Entity type:Organization
Organization Name:TENDER HEART HOME CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:RAY
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-719-4444
Mailing Address - Street 1:2733 N POWER RD
Mailing Address - Street 2:#102-453
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85215-1682
Mailing Address - Country:US
Mailing Address - Phone:480-719-4444
Mailing Address - Fax:480-719-4445
Practice Address - Street 1:2733 N POWER RD
Practice Address - Street 2:#102-453
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85215-1682
Practice Address - Country:US
Practice Address - Phone:480-719-4444
Practice Address - Fax:480-719-4445
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-25
Last Update Date:2012-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ689046Medicaid