Healthcare Provider Details

I. General information

NPI: 1306323159
Provider Name (Legal Business Name): TENDER LOVING CARE HOMECARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/24/2018
Last Update Date: 08/01/2025
Certification Date: 08/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1104 W 1ST STREET SUITE 1
LAUREL MS
39440-3991
US

IV. Provider business mailing address

11 MAPLE DR
ELLISVILLE MS
39437-4484
US

V. Phone/Fax

Practice location:
  • Phone: 601-319-3985
  • Fax:
Mailing address:
  • Phone: 601-319-3985
  • 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 Code376J00000X
TaxonomyHomemaker
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State

VIII. Authorized Official

Name: MRS. LUCINDA PETERS
Title or Position: OWNER
Credential:
Phone: 601-319-3985