Healthcare Provider Details

I. General information

NPI: 1073150470
Provider Name (Legal Business Name): TRUE TENDER LOVING CARE ADULT FOSTERING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/04/2019
Last Update Date: 12/04/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3407 DOLORES AVE
WARREN MI
48091-1689
US

IV. Provider business mailing address

3407 DOLORES AVE
WARREN MI
48091-1689
US

V. Phone/Fax

Practice location:
  • Phone: 586-459-8679
  • Fax: 586-393-1548
Mailing address:
  • Phone: 586-459-8679
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code372600000X
TaxonomyAdult Companion
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State

VIII. Authorized Official

Name: ANDREA L CHARLTON
Title or Position: OWNER
Credential:
Phone: 586-459-8679