MEDICARE: C&J TENDER HEART RESIDENTIAL SERVICES , 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
2	251C00000X	Developmentally Disabled Services Day Training Agency

General Provider Information

NPI Number	:	1295322030
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	C&J TENDER HEART RESIDENTIAL SERVICES , LLC

Provider Business Mailing Address
First Line	:	5660 SOUTHWYCK BLVD # 250260
Second Line	:
City	:	TOLEDO
State	:	OH
Zip	:	43614-1566
Country	:	US
Telephone Number	:	419-508-5936
Fax Number	:	567-742-7301

Provider Business Practice Location Address
First Line	:	5660 SOUTHWYCK BLVD # 250260
Second Line	:
City	:	TOLEDO
State	:	OH
Zip	:	43614-1566
Country	:	US
Telephone Number	:	419-508-5936
Fax Number	:	567-742-7301

Authorized Official
Title or Position	:	OWNER
Name	:	CARLENA JOHNSON
Credential	:
Telephone Number	:	419-508-5936

Provider Enumeration Date	:	12/28/2020
Last Update Date	:	09/22/2023

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