=====================================================
General NPI Number Information
=====================================================
NPI Number | 1295793966
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | TENDER HEART HOSPICE CARE LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/03/2006
-----------------------------------------------------
Last Update Date | 10/27/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3210 W PARK ROW DR
-----------------------------------------------------
City | ARLINGTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 76013-3153
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 817-265-0066
-----------------------------------------------------
Fax | 817-265-0089
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3210 W PARK ROW DR
-----------------------------------------------------
City | ARLINGTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 76013-3153
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 817-265-0066
-----------------------------------------------------
Fax | 817-265-0089
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ADMINISTRATOR
-----------------------------------------------------
Name | MRS. KOFO KAY SERIKI
-----------------------------------------------------
Credential | MPA
-----------------------------------------------------
Telephone | 817-265-0066
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251G00000X
-----------------------------------------------------
Taxonomy Name | Community Based Hospice Care Agency
-----------------------------------------------------
License Number | 009440
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------