1013961267 NPI number — TENDER LOVING CARE HEALTH CARE SERVICES WESTERN, LLC

Table of content: (NPI 1013961267)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1013961267 NPI number — TENDER LOVING CARE HEALTH CARE SERVICES WESTERN, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TENDER LOVING CARE HEALTH CARE SERVICES WESTERN, 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:
6
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:
1013961267
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/24/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3854 AMERICAN WAY
Provider Second Line Business Mailing Address:
SUITE A
Provider Business Mailing Address City Name:
BATON ROUGE
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
70816-4013
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
225-292-2031
Provider Business Mailing Address Fax Number:
225-295-9678

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
645 E MISSOURI AVE STE 265
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PHOENIX
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85012-0005
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
602-200-0835
Provider Business Practice Location Address Fax Number:
602-200-8465
Provider Enumeration Date:
05/20/2006

Additional Information

Authorized Official

Authorized Official Last Name:
MIGLICCO
Authorized Official First Name:
TRAVIS
Authorized Official Middle Name:
Authorized Official Title or Position:
VP TAX
Authorized Official Telephone Number:
225-299-3803

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X , with the licence number:  HHA3720 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 037106 . This is a "GROUP HEALTH COOPERATIVE" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: 958879 . This is a "ARIZONA PHYSICIAN IPA" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: 037106 . This is a "HUMANA PPS" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: 958879 , issued by the state of ( AZ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 037106 . This is a "SECURE HORIZONS DIRECT PP" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".




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