Provider Demographics
NPI:1811124803
Name:TENDER HANDS ADULT HEALTH DAYCARE
Entity type:Organization
Organization Name:TENDER HANDS ADULT HEALTH DAYCARE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:WILBUR
Authorized Official - Last Name:BOUSMAN
Authorized Official - Suffix:JR
Authorized Official - Credentials:REV
Authorized Official - Phone:573-431-5300
Mailing Address - Street 1:POBOX 1539
Mailing Address - Street 2:6500 DUNN RD.
Mailing Address - City:DESLOGE
Mailing Address - State:MO
Mailing Address - Zip Code:63601-1539
Mailing Address - Country:US
Mailing Address - Phone:573-431-5300
Mailing Address - Fax:573-431-5300
Practice Address - Street 1:6500 DUNN RD
Practice Address - Street 2:
Practice Address - City:DESLOGE
Practice Address - State:MO
Practice Address - Zip Code:63601-1539
Practice Address - Country:US
Practice Address - Phone:573-431-5300
Practice Address - Fax:573-431-5300
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HOUSE OF PRAISE CHURCH OF GOD
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-06-17
Last Update Date:2009-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO802385H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385H00000XRespite Care FacilityRespite Care