Healthcare Provider Details

I. General information

NPI: 1376727503
Provider Name (Legal Business Name): TENDER LOVING CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/24/2007
Last Update Date: 07/15/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

714 1ST STREET
CLEVELAND MS
38732
US

IV. Provider business mailing address

POST OFFICE BOX 893
CLEVELAND MS
38732
US

V. Phone/Fax

Practice location:
  • Phone: 662-846-1115
  • Fax: 662-843-4550
Mailing address:
  • Phone: 662-846-1115
  • Fax: 662-843-4550

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number04130501
License Number State

VIII. Authorized Official

Name: MRS. PEARLIE CARTER
Title or Position: DIRECTOR
Credential:
Phone: 662-846-1115