Provider Demographics
NPI:1750335824
Name:TENDER LOVING CARE HEALTH CARE SERVICES WESTERN, LLC
Entity type:Organization
Organization Name:TENDER LOVING CARE HEALTH CARE SERVICES WESTERN, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:B
Authorized Official - Last Name:KUSSEROW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:225-292-2031
Mailing Address - Street 1:3854 AMERICAN WAY
Mailing Address - Street 2:SUITE A
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70816-4013
Mailing Address - Country:US
Mailing Address - Phone:225-292-2031
Mailing Address - Fax:225-295-9678
Practice Address - Street 1:1350 BAYSHORE HWY
Practice Address - Street 2:SUITE 777
Practice Address - City:BURLINGAME
Practice Address - State:CA
Practice Address - Zip Code:94010-1823
Practice Address - Country:US
Practice Address - Phone:650-652-9128
Practice Address - Fax:650-652-9836
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TLC HEALTH CARE SERVICES, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-05-21
Last Update Date:2016-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA220000139251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAHHA57116GOtherHEALTH PLAN OF SAN MATEO
CAHHA57116GMedicaid
CA557116OtherCALIFORNIA BC BS
CAHHA57116GOtherBLUE CROSS MEDI CAL GMC
CA557116OtherCALIFORNIA BC BS