=====================================================
General NPI Number Information
=====================================================
NPI Number | 1548426646
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | TENDER CARE COMPANY, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/29/2008
-----------------------------------------------------
Last Update Date | 10/30/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 674 OCEAN HWY W
-----------------------------------------------------
City | SUPPLY
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28462-4048
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 910-641-0037
-----------------------------------------------------
Fax | 877-224-4363
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 127
-----------------------------------------------------
City | WHITEVILLE
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28472-0127
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 910-642-2757
-----------------------------------------------------
Fax | 877-224-4363
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MANAGER/ DIRECTOR
-----------------------------------------------------
Name | MRS. CASSANDRA FELICA CORBETT
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 910-641-0037
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251S00000X
-----------------------------------------------------
Taxonomy Name | Community/Behavioral Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------