1437470655 NPI number — TENDER LOVING CARE SERVICES MIDWEST, LLC

Table of content: (NPI 1437470655)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1437470655 NPI number — TENDER LOVING CARE SERVICES MIDWEST, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TENDER LOVING CARE SERVICES MIDWEST, 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:
1437470655
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/22/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5959 S SHERWOOD FOREST BLVD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BATON ROUGE
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
70816-6038
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
225-298-3548
Provider Business Mailing Address Fax Number:
225-295-9678

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4920 E STATE ST
Provider Second Line Business Practice Location Address:
SUITE 2
Provider Business Practice Location Address City Name:
ROCKFORD
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
61108-2272
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
815-229-2605
Provider Business Practice Location Address Fax Number:
815-229-2947
Provider Enumeration Date:
06/22/2010

Additional Information

Authorized Official

Authorized Official Last Name:
BORNE
Authorized Official First Name:
WILLAIM
Authorized Official Middle Name:
F
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
225-292-2031

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X , with the licence number:  1010376 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 2001032204001 , issued by the state of ( IL ) . This identifiers is of the category "MEDICAID".




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