1376215392 NPI number — TENDER HEARTS HOME CARE AGENCY LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1376215392 NPI number — TENDER HEARTS HOME CARE AGENCY LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TENDER HEARTS HOME CARE AGENCY LLC
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:
Provider Other Organization Name Type Code:
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:
1376215392
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/28/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1 OLYMPIC PL STE 900
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TOWSON
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21204-4113
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
667-205-2103
Provider Business Mailing Address Fax Number:
667-777-1996

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1 OLYMPIC PL STE 900
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TOWSON
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21204-4113
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
667-205-2103
Provider Business Practice Location Address Fax Number:
667-777-1996
Provider Enumeration Date:
09/28/2021

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
WALKER-PAYLOR
Authorized Official First Name:
MAXINE
Authorized Official Middle Name:
NICOLE
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
410-937-4042

Provider Taxonomy Codes

  • Taxonomy code: 253Z00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: A00024822 . This is a "CERTIFIED NURSING ASSISTANT" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".