=====================================================
General NPI Number Information
=====================================================
NPI Number | 1184089997
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | TENDER KARE SERVICES, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/21/2015
-----------------------------------------------------
Last Update Date | 12/21/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4443 BETHEL CHURCH RD 37
-----------------------------------------------------
City | COLUMBIA
-----------------------------------------------------
State | SC
-----------------------------------------------------
Zip | 29206-1292
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 478-334-4406
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4443 BETHEL CHURCH RD 37
-----------------------------------------------------
City | COLUMBIA
-----------------------------------------------------
State | SC
-----------------------------------------------------
Zip | 29206-1292
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MS. KHIALLAH SOLOMON
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 478-334-4406
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number | 16979
-----------------------------------------------------
License Number State | SC
-----------------------------------------------------