=====================================================
General NPI Number Information
=====================================================
NPI Number | 1669011854
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | T & K LOVE AND CARING SERVICES,INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/05/2020
-----------------------------------------------------
Last Update Date | 01/05/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 941 S PARK RD APT 101
-----------------------------------------------------
City | HOLLYWOOD
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33021-8764
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 786-492-0196
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1414 S PARROTT AVE # 330
-----------------------------------------------------
City | OKEECHOBEE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34974-5276
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | TAMMIE HENDERSON
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 786-492-0196
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251C00000X
-----------------------------------------------------
Taxonomy Name | Developmentally Disabled Services Day Training Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------