Healthcare Provider Details

I. General information

NPI: 1295322030
Provider Name (Legal Business Name): C&J TENDER HEART RESIDENTIAL SERVICES , LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/28/2020
Last Update Date: 09/22/2023
Certification Date: 09/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5660 SOUTHWYCK BLVD # 250260
TOLEDO OH
43614-1566
US

IV. Provider business mailing address

5660 SOUTHWYCK BLVD # 250260
TOLEDO OH
43614-1566
US

V. Phone/Fax

Practice location:
  • Phone: 419-508-5936
  • Fax: 567-742-7301
Mailing address:
  • Phone: 419-508-5936
  • Fax: 567-742-7301

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: CARLENA JOHNSON
Title or Position: OWNER
Credential:
Phone: 419-508-5936