1831143908 NPI number — TENDER LOVING CARE HEALTH CARE SERVICES SOUTHEAST, LLC

Table of content: DIANE M ERPS (NPI 1801923875)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1831143908 NPI number — TENDER LOVING CARE HEALTH CARE SERVICES SOUTHEAST, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TENDER LOVING CARE HEALTH CARE SERVICES SOUTHEAST, 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:
1831143908
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/04/2025
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:
70816-4013
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:
1401 MERCANTILE LN
Provider Second Line Business Practice Location Address:
SUITE 351
Provider Business Practice Location Address City Name:
LARGO
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
20774-4301
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
301-322-6023
Provider Business Practice Location Address Fax Number:
301-322-6858
Provider Enumeration Date:
05/21/2006

Additional Information

Authorized Official

Authorized Official Last Name:
MIGLICCO
Authorized Official First Name:
TRAVIS
Authorized Official Middle Name:
Authorized Official Title or Position:
SVP TAX
Authorized Official Telephone Number:
225-299-3803

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X , with the licence number:  HH7149 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 201031840018 . This is a "TRICARE HEALTH NET" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 4046951000 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".
  • Identifier: 420716500 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".




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