1770537854 NPI number — TENDER LOVING CARE HEALTH CARE SERVICES OF NEW ENGLAND, LLC

Table of content: (NPI 1770537854)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1770537854 NPI number — TENDER LOVING CARE HEALTH CARE SERVICES OF NEW ENGLAND, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TENDER LOVING CARE HEALTH CARE SERVICES OF NEW ENGLAND, 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:
1770537854
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/09/2017
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:
70816-4896
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:
300 CENTERVILLE RD
Provider Second Line Business Practice Location Address:
SUITE 202
Provider Business Practice Location Address City Name:
WARWICK
Provider Business Practice Location Address State Name:
RI
Provider Business Practice Location Address Postal Code:
02886-0200
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
401-737-4236
Provider Business Practice Location Address Fax Number:
401-738-1618
Provider Enumeration Date:
05/21/2006

Additional Information

Authorized Official

Authorized Official Last Name:
KUSSEROW
Authorized Official First Name:
PAUL
Authorized Official Middle Name:
B
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
225-292-2031

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X , with the licence number:  HNC02310 , registered in the state of RI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 251E00000X , with the licence number: HNC02355 , registered in the state of RI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 251E00000X , with the licence number: HNC02384 , registered in the state of RI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 407349 002 . This is a "RI BLUE CHIP" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".
  • Identifier: 5881 4 . This is a "RI HEALTHMATE COAST TO CO" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".
  • Identifier: 5881 4 . This is a "RI BLUE CROSS BLUE SHEILD" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".
  • Identifier: 1758A 2146 . This is a "NIEGHBORHOOD HEALTH PLAN" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".
  • Identifier: 407349 002 . This is a "RI BLUE CHIP PLUS CHO" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".
  • Identifier: TL56604 , issued by the state of ( RI ) . This identifiers is of the category "MEDICAID".
  • Identifier: TL57250 , issued by the state of ( RI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 407349 002 . This is a "RI BEHAVIORAL HEALTH" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".
  • Identifier: 5881-4 . This is a "RI BEACON MUTUAL INS. CO." identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".
  • Identifier: TL57249 , issued by the state of ( RI ) . This identifiers is of the category "MEDICAID".




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