Provider Demographics
NPI:1720514896
Name:TENDER LOVING CARE HOME FOR BOYS, INC
Entity Type:Organization
Organization Name:TENDER LOVING CARE HOME FOR BOYS, INC
Other - Org Name:CORINTHIANS HELPING HAND GROUP HOMES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:REGINALD
Authorized Official - Middle Name:
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:SR
Authorized Official - Credentials:
Authorized Official - Phone:909-243-2307
Mailing Address - Street 1:11519 CARLISLE PLACE
Mailing Address - Street 2:
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91730
Mailing Address - Country:US
Mailing Address - Phone:909-484-7259
Mailing Address - Fax:
Practice Address - Street 1:11519 CARLISLE PL
Practice Address - Street 2:
Practice Address - City:RANCHO CUCAMONGA
Practice Address - State:CA
Practice Address - Zip Code:91730-7233
Practice Address - Country:US
Practice Address - Phone:909-484-7259
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-10
Last Update Date:2017-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA366405647322D00000X
CA366407775322D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children