Provider Demographics
NPI:1912613068
Name:KAY TENDER CARE LLC
Entity Type:Organization
Organization Name:KAY TENDER CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:NERLIN
Authorized Official - Middle Name:
Authorized Official - Last Name:STFLEUR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-317-0764
Mailing Address - Street 1:178 GLEN EAGLE WAY
Mailing Address - Street 2:
Mailing Address - City:MCDONOUGH
Mailing Address - State:GA
Mailing Address - Zip Code:30253-4228
Mailing Address - Country:US
Mailing Address - Phone:561-317-0764
Mailing Address - Fax:
Practice Address - Street 1:178 GLEN EAGLE WAY
Practice Address - Street 2:
Practice Address - City:MCDONOUGH
Practice Address - State:GA
Practice Address - Zip Code:30253-4228
Practice Address - Country:US
Practice Address - Phone:561-317-0764
Practice Address - Fax:404-341-7626
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-23
Last Update Date:2023-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA2006Medicaid