Healthcare Provider Details

I. General information

NPI: 1275088361
Provider Name (Legal Business Name): TENDER CARE PCH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/18/2016
Last Update Date: 08/18/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1752 NORTHWICK PL
LITHONIA GA
30058-5590
US

IV. Provider business mailing address

1752 NORTHWICK PL
LITHONIA GA
30058-5590
US

V. Phone/Fax

Practice location:
  • Phone: 414-678-8767
  • Fax:
Mailing address:
  • Phone: 414-678-8767
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: DELLAREESE WILLIAMS
Title or Position: DIRECTOR
Credential:
Phone: 414-678-8767