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General NPI Number Information
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NPI Number | 1881217610
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Entity Type | Organization
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Legal Business Name | TENDER CARE HOME AWAY FROM HOME LLC
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Dates
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Enumeration Date | 05/27/2020
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Last Update Date | 05/28/2025
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Provider Practice Location Address
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Address Line | 8925 W STARK ST
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City | MILWAUKEE
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State | WI
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Zip | 53225-4114
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Country | US
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Telephone | 414-574-8052
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Fax |
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Provider Business Mailing Address
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Address Line | 8925 W STARK ST
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City | MILWAUKEE
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State | WI
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Zip | 53225-4114
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Country | US
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Telephone | 414-574-8052
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | CHERYL YVETTE CLAYBROOKS
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Credential |
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Telephone | 414-574-8052
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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 |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 3104A0625X
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Taxonomy Name | Assisted Living Facility (Mental Illness)
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 3104A0630X
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Taxonomy Name | Assisted Living Facility (Behavioral Disturbances)
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 385H00000X
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Taxonomy Name | Respite Care
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number |
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License Number State |
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