MEDICARE: TENDER MOMENTS CONSUMER DIRECTD 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	253Z00000X	In Home Supportive Care Agency		MO

General Provider Information

NPI Number	:	1700209889
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TENDER MOMENTS CONSUMER DIRECTD SERVICES LLC

Provider Business Mailing Address
First Line	:	1319 HARTING DR
Second Line	:
City	:	FLORISSANT
State	:	MO
Zip	:	63031-1977
Country	:	US
Telephone Number	:	314-625-1306
Fax Number	:

Provider Business Practice Location Address
First Line	:	1319 HARTING DR
Second Line	:
City	:	FLORISSANT
State	:	MO
Zip	:	63031-1977
Country	:	US
Telephone Number	:	314-625-1306
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR/ MANAGER
Name	:	MRS. KIONNA JACKSON
Credential	:
Telephone Number	:	314-625-1306

Provider Enumeration Date	:	01/27/2014
Last Update Date	:	01/27/2014

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