Provider Demographics
NPI:1477674125
Name:TENDER LOVING CARE HOME CARE INC.
Entity type:Organization
Organization Name:TENDER LOVING CARE HOME CARE INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:FELISA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:DUDLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-625-7166
Mailing Address - Street 1:8218 HAZELBRAND RD NE
Mailing Address - Street 2:SUITE B
Mailing Address - City:COVINGTON
Mailing Address - State:GA
Mailing Address - Zip Code:30014-1502
Mailing Address - Country:US
Mailing Address - Phone:706-468-5151
Mailing Address - Fax:678-625-7167
Practice Address - Street 1:8218 HAZELBRAND RD NE
Practice Address - Street 2:SUITE B
Practice Address - City:COVINGTON
Practice Address - State:GA
Practice Address - Zip Code:30014-1502
Practice Address - Country:US
Practice Address - Phone:706-468-5151
Practice Address - Fax:678-625-7167
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-02
Last Update Date:2009-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA079-R-0001251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA960910942AMedicaid
GA960910942CMedicaid