Provider Demographics
NPI:1720265424
Name:TENDER LOVING CARE PROVIDERS, INC.
Entity Type:Organization
Organization Name:TENDER LOVING CARE PROVIDERS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED PRACTICAL NURSE
Authorized Official - Prefix:MRS
Authorized Official - First Name:BRIDGETTE
Authorized Official - Middle Name:ANNETTA
Authorized Official - Last Name:HARRIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-644-4283
Mailing Address - Street 1:6494 N. W. GROVELAND TERRACE
Mailing Address - Street 2:
Mailing Address - City:PORT ST. LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34986-3825
Mailing Address - Country:US
Mailing Address - Phone:561-644-4283
Mailing Address - Fax:
Practice Address - Street 1:6494 N. W. GROVELAND TERRACE
Practice Address - Street 2:
Practice Address - City:PORT ST. LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34986-3825
Practice Address - Country:US
Practice Address - Phone:561-644-4283
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-24
Last Update Date:2008-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
164W00000X
FLPN1068941251E00000X, 251G00000X, 251J00000X, 310400000X, 311ZA0620X, 343900000X, 347C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes347C00000XTransportation ServicesPrivate Vehicle
No164W00000XNursing Service ProvidersLicensed Practical NurseGroup - Single Specialty
No251E00000XAgenciesHome Health
No251G00000XAgenciesHospice Care, Community BasedGroup - Single Specialty
No251J00000XAgenciesNursing Care
No310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
No311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL692853696Medicaid