1053623140 NPI number — TENDER LOVING CARE HOMES, INC.

Table of content: GERRY STETSON HAYES M.D. (NPI 1255397188)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1053623140 NPI number — TENDER LOVING CARE HOMES, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TENDER LOVING CARE HOMES, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
NC BROOK HAVEN BEHAVIORAL
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1053623140
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/31/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1854 HENDERSONVILLE RD
Provider Second Line Business Mailing Address:
UNIT 114
Provider Business Mailing Address City Name:
ASHEVILLE
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28803-2494
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
828-651-0333
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2 WALDEN RIDGE DRIVE
Provider Second Line Business Practice Location Address:
SUITE #30
Provider Business Practice Location Address City Name:
ASHEVILLE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28803-3306
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
828-676-1657
Provider Business Practice Location Address Fax Number:
828-651-9083
Provider Enumeration Date:
07/06/2010

Additional Information

Authorized Official

Authorized Official Last Name:
BAKER
Authorized Official First Name:
JACQUELINE
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
828-676-1657

Provider Taxonomy Codes

  • Taxonomy code: 251S00000X , with the licence number:  MHL-011-274 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 320900000X , with the licence number: MHL-011-274 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 3418503 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 8303121 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".




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