Healthcare Provider Details

I. General information

NPI: 1487729307
Provider Name (Legal Business Name): TENDER HEART ADULT DAY HEALTH CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/24/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9499 I AVE
HESPERIA CA
92345-6282
US

IV. Provider business mailing address

9499 I AVE
HESPERIA CA
92345-6282
US

V. Phone/Fax

Practice location:
  • Phone: 760-244-8776
  • Fax: 760-244-9456
Mailing address:
  • Phone: 760-244-8776
  • Fax: 760-244-9456

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number StateCA

VIII. Authorized Official

Name: MRS. NELLY SUPAPO LIZASO
Title or Position: ADMINISTRATOR
Credential: MBA
Phone: 760-244-8776