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General NPI Number Information
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NPI Number | 1053480509
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Entity Type | Organization
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Legal Business Name | TENDER LOVE PCA SERVICES LLC
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Dates
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Enumeration Date | 11/07/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 4686 GROOM RD STE D
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City | BAKER
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State | LA
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Zip | 70714-3049
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Country | US
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Telephone | 225-775-6011
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Fax | 225-775-6078
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Provider Business Mailing Address
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Address Line | 4686 GROOM RD STE D
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City | BAKER
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State | LA
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Zip | 70714-3049
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Country | US
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Telephone | 225-775-6011
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Fax | 225-775-6078
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Authorized Official
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Title or Position | OWNER
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Name | MS. NORA LYNETTY COSSETT
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Credential | LPN
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Telephone | 225-775-6011
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251C00000X
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Taxonomy Name | Developmentally Disabled Services Day Training Agency
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License Number | 12245
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License Number State | LA
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