MEDICARE: TENDER LOVING CARE HEALTH CARE SERVICES OF WESTERN NEW YORK, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251E00000X	Home Health Agency	1324L003	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1189203	OTHER	NY	UNIVERSAL HEALTH CARE
2	8390061	OTHER	NY	NY INDEPENDENT HEALTH
3	201031840028	OTHER	NY	NY HEALTH NOW INFUSION
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1255466108
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TENDER LOVING CARE HEALTH CARE SERVICES OF WESTERN NEW YORK, LLC

Provider Business Mailing Address
First Line	:	1983 MARCUS AVE
Second Line	:	STE 200
City	:	NEW HYDE PARK
State	:	NY
Zip	:	11042-1016
Country	:	US
Telephone Number	:	516-358-1000
Fax Number	:

Provider Business Practice Location Address
First Line	:	3784 COMMERCE CT
Second Line	:	SUITE 400
City	:	NORTH TONAWANDA
State	:	NY
Zip	:	14120-2024
Country	:	US
Telephone Number	:	716-807-0100
Fax Number	:

Authorized Official
Title or Position	:	CFO
Name	:	WILLARD T DERR
Credential	:
Telephone Number	:	516-358-1000

Provider Enumeration Date	:	02/22/2007
Last Update Date	:	07/19/2007

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