Healthcare Provider Details

I. General information

NPI: 1912199738
Provider Name (Legal Business Name): TENDERCARE HOME SERVICES INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/15/2007
Last Update Date: 08/15/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9700 45TH AVE N
PLYMOUTH MN
55442-2664
US

IV. Provider business mailing address

4957 BROOKLYN BLVD
BROOKLYN CENTER MN
55429-3405
US

V. Phone/Fax

Practice location:
  • Phone: 763-551-7326
  • Fax:
Mailing address:
  • Phone: 763-535-5113
  • Fax: 763-537-2553

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2278H0200X
TaxonomyHome Health Certified Respiratory Therapist
License Number
License Number State

VIII. Authorized Official

Name: MRS. JENIFER LYNN MALOBE
Title or Position: PRESIDENT
Credential:
Phone: 763-535-5113