Provider Demographics
NPI:1659103638
Name:TYMAX CARE,LLC
Entity type:Organization
Organization Name:TYMAX CARE,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MAXWELL
Authorized Official - Middle Name:YAOVI
Authorized Official - Last Name:TENGUE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-770-7512
Mailing Address - Street 1:2705 OAK GROVE RD
Mailing Address - Street 2:
Mailing Address - City:LOGANVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30052-8902
Mailing Address - Country:US
Mailing Address - Phone:678-770-7512
Mailing Address - Fax:
Practice Address - Street 1:67 BRYANT ST
Practice Address - Street 2:
Practice Address - City:JASPER
Practice Address - State:GA
Practice Address - Zip Code:30143-1480
Practice Address - Country:US
Practice Address - Phone:706-253-1080
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-17
Last Update Date:2024-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health