Healthcare Provider Details

I. General information

NPI: 1922349539
Provider Name (Legal Business Name): TENDER LOVING HOSPITALITY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/06/2013
Last Update Date: 03/06/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

125 NE 9TH AVE
CRYSTAL RIVER FL
34429-4425
US

IV. Provider business mailing address

125 NE 9TH AVE
CRYSTAL RIVER FL
34429-4425
US

V. Phone/Fax

Practice location:
  • Phone: 352-563-1218
  • Fax: 352-563-0511
Mailing address:
  • Phone: 352-563-1218
  • Fax: 352-563-0511

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3104A0625X
TaxonomyAssisted Living Facility (Mental Illness)
License NumberAL8652
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code347C00000X
TaxonomyPrivate Vehicle
License NumberAL8652
License Number StateFL

VIII. Authorized Official

Name: MRS. DRUCELLA DIXON DEVAUGHN
Title or Position: OWNER/ADMINISTRATOR
Credential:
Phone: 354-563-1218