=====================================================
General NPI Number Information
=====================================================
NPI Number | 1629279559
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | THE HOUSE OF TENDER LOVING CARE
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/29/2007
-----------------------------------------------------
Last Update Date | 06/18/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 817 FALL WHEAT DR
-----------------------------------------------------
City | DESOTO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75115-6071
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 972-223-1212
-----------------------------------------------------
Fax | 972-230-2256
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 817 FALL WHEAT DR
-----------------------------------------------------
City | DESOTO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75115-6071
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 972-223-1212
-----------------------------------------------------
Fax | 972-230-2256
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | EXEC. ADMIN.
-----------------------------------------------------
Name | MS. TINA MATRELLE TURNER
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 972-223-1212
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3104A0625X
-----------------------------------------------------
Taxonomy Name | Assisted Living Facility (Mental Illness)
-----------------------------------------------------
License Number | 119054
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------