1215981394 NPI number — TENDEDR LOVING CARE HEALTH CARE SERVICES OF PA, LLC

Table of content: (NPI 1215981394)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1215981394 NPI number — TENDEDR LOVING CARE HEALTH CARE SERVICES OF PA, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TENDEDR LOVING CARE HEALTH CARE SERVICES OF PA, 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:
1215981394
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:
401 COMMERCE DR
Provider Second Line Business Practice Location Address:
2ND FL
Provider Business Practice Location Address City Name:
FT WASHINGTON
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19034-2714
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-646-9401
Provider Business Practice Location Address Fax Number:
215-646-9543
Provider Enumeration Date:
05/21/2006

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:  756705 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 30022841 . This is a "PA KEYSTONE MERCY HEALTH" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 1014935910002 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".




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