1093769226 NPI number — TENDER LOVING CARE HEALTH CARE SERVICES WESTERN, LLC

Table of content: (NPI 1093769226)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1093769226 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:
1093769226
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/19/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1983 MARCUS AVE
Provider Second Line Business Mailing Address:
STE 200
Provider Business Mailing Address City Name:
LAKE SUCCESS
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11042-1016
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
516-358-1000
Provider Business Mailing Address Fax Number:
516-327-8636

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2111 N NORTHGATE WAY
Provider Second Line Business Practice Location Address:
STE 103
Provider Business Practice Location Address City Name:
SEATTLE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98133-9018
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-729-3900
Provider Business Practice Location Address Fax Number:
206-729-6125
Provider Enumeration Date:
05/20/2006

Additional Information

Authorized Official

Authorized Official Last Name:
DERR
Authorized Official First Name:
WILLARD
Authorized Official Middle Name:
T
Authorized Official Title or Position:
CFO
Authorized Official Telephone Number:
516-358-1000

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X , with the licence number:  IS-449 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 9056953 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com