MEDICARE: TENDER LOVING CARE PROVIDERS, INC.

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	251G00000X	Community Based Hospice Care Agency	PN1068941	FL
2	343900000X	Non-emergency Medical Transport (VAN)	PN1068941	FL
3	164W00000X	Licensed Practical Nurse
4	310400000X	Assisted Living Facility	PN1068941	FL
5	251E00000X	Home Health Agency	PN1068941	FL
6	251J00000X	Nursing Care Agency	PN1068941	FL
7	311ZA0620X	Adult Care Home Facility	PN1068941	FL
8	347C00000X	Private Vehicle	PN1068941	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1720265424
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TENDER LOVING CARE PROVIDERS, INC.

Provider Business Mailing Address
First Line	:	6494 N. W. GROVELAND TERRACE
Second Line	:
City	:	PORT ST. LUCIE
State	:	FL
Zip	:	34986-3825
Country	:	US
Telephone Number	:	561-644-4283
Fax Number	:

Provider Business Practice Location Address
First Line	:	6494 N. W. GROVELAND TERRACE
Second Line	:
City	:	PORT ST. LUCIE
State	:	FL
Zip	:	34986-3825
Country	:	US
Telephone Number	:	561-644-4283
Fax Number	:

Authorized Official
Title or Position	:	LICENSED PRACTICAL NURSE
Name	:	MRS. BRIDGETTE ANNETTA HARRIS
Credential	:
Telephone Number	:	561-644-4283

Provider Enumeration Date	:	01/24/2008
Last Update Date	:	06/19/2008

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