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General NPI Number Information
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NPI Number | 1295322030
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Entity Type | Organization
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Legal Business Name | C&J TENDER HEART RESIDENTIAL SERVICES , LLC
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Dates
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Enumeration Date | 12/28/2020
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Last Update Date | 09/22/2023
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Provider Practice Location Address
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Address Line | 5660 SOUTHWYCK BLVD # 250260
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City | TOLEDO
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State | OH
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Zip | 43614-1566
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Country | US
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Telephone | 419-508-5936
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Fax | 567-742-7301
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Provider Business Mailing Address
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Address Line | 5660 SOUTHWYCK BLVD # 250260
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City | TOLEDO
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State | OH
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Zip | 43614-1566
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Country | US
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Telephone | 419-508-5936
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Fax | 567-742-7301
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Authorized Official
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Title or Position | OWNER
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Name | CARLENA JOHNSON
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Credential |
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Telephone | 419-508-5936
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number |
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License Number State |
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Taxonomy #2
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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 |
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License Number State |
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