1053623140 NPI number — TENDER LOVING CARE HOMES, INC.

Table of content: (NPI 1053623140)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1053623140 NPI number — TENDER LOVING CARE HOMES, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TENDER LOVING CARE HOMES, INC.
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:
1053623140
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/31/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1854 HENDERSONVILLE RD
Provider Second Line Business Mailing Address:
UNIT 114
Provider Business Mailing Address City Name:
ASHEVILLE
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28803-2494
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
828-651-0333
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2 WALDEN RIDGE DRIVE
Provider Second Line Business Practice Location Address:
SUITE #30
Provider Business Practice Location Address City Name:
ASHEVILLE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28803-3306
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
828-676-1657
Provider Business Practice Location Address Fax Number:
828-651-9083
Provider Enumeration Date:
07/06/2010

Additional Information

Authorized Official

Authorized Official Last Name:
BAKER
Authorized Official First Name:
JACQUELINE
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
828-676-1657

Provider Taxonomy Codes

  • Taxonomy code: 251S00000X , with the licence number:  MHL-011-274 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 320900000X , with the licence number: MHL-011-274 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 3418503 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 8303121 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".




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