Provider Demographics
NPI:1780906065
Name:TENDER CARE MEDICAL SERVICES OF ST JOHNS INC
Entity type:Organization
Organization Name:TENDER CARE MEDICAL SERVICES OF ST JOHNS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PHILIP
Authorized Official - Middle Name:
Authorized Official - Last Name:MAZZUCO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:352-683-6831
Mailing Address - Street 1:PO BOX 5159
Mailing Address - Street 2:
Mailing Address - City:SPRING HILL
Mailing Address - State:FL
Mailing Address - Zip Code:34611-5159
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6 SAINT JOHNS MEDICAL PK DR
Practice Address - Street 2:
Practice Address - City:ST AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32086-5298
Practice Address - Country:US
Practice Address - Phone:352-683-6831
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-27
Last Update Date:2010-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
No3140N1450XNursing & Custodial Care FacilitiesSkilled Nursing FacilityNursing Care, PediatricGroup - Multi-Specialty
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty