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General NPI Number Information
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NPI Number | 1659526358
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Entity Type | Organization
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Legal Business Name | TENDER HEARTS ENTERPRISES, LLC
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Dates
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Enumeration Date | 11/21/2008
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Last Update Date | 11/21/2008
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Provider Practice Location Address
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Address Line | 120 ESTATES CIR
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City | LAKE MARY
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State | FL
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Zip | 32746-3043
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Country | US
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Telephone | 407-529-4787
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Fax | 800-546-8385
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Provider Business Mailing Address
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Address Line | 478 E ALTAMONTE DR SUITE 108-205Q
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City | ALTAMONTE SPRINGS
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State | FL
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Zip | 32701-4628
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Country | US
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Telephone | 407-529-4787
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Fax |
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Authorized Official
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Title or Position | SR. PARTNER
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Name | MR. TIMOTEO JUAN CHACON
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Credential | CRNA/ARNP
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Telephone | 407-529-9292
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number | 10326
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License Number State | FL
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