1194274829 NPI number — TENDER CARE TRANSPORT LLC

Table of content: (NPI 1194274829)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1194274829 NPI number — TENDER CARE TRANSPORT LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TENDER CARE TRANSPORT 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:
1194274829
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/22/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1223 POLK XING
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MCDONOUGH
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30252-8070
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
478-951-4048
Provider Business Mailing Address Fax Number:
478-352-0004

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
725 MAGNOLIA DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MACON
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
31217-4139
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
478-951-4048
Provider Business Practice Location Address Fax Number:
478-352-0004
Provider Enumeration Date:
09/22/2016

Additional Information

Authorized Official

Authorized Official Last Name:
BENNETT
Authorized Official First Name:
BERNITA
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO/PRESIDENT
Authorized Official Telephone Number:
478-951-4048

Provider Taxonomy Codes

  • Taxonomy code: 343900000X , with the licence number:  RAU2233 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1001182 . This is a "MACON-BIBB COUNTY BUSINESS LICENSE" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com