MEDICARE: TENDER LOVING CARE HEALTH CARE SERVICES WESTERN, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251E00000X	Home Health Agency	IS-449	WA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1093769226
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TENDER LOVING CARE HEALTH CARE SERVICES WESTERN, LLC

Provider Business Mailing Address
First Line	:	1983 MARCUS AVE
Second Line	:	STE 200
City	:	LAKE SUCCESS
State	:	NY
Zip	:	11042-1016
Country	:	US
Telephone Number	:	516-358-1000
Fax Number	:	516-327-8636

Provider Business Practice Location Address
First Line	:	2111 N NORTHGATE WAY
Second Line	:	STE 103
City	:	SEATTLE
State	:	WA
Zip	:	98133-9018
Country	:	US
Telephone Number	:	206-729-3900
Fax Number	:	206-729-6125

Authorized Official
Title or Position	:	CFO
Name	:	WILLARD T DERR
Credential	:
Telephone Number	:	516-358-1000

Provider Enumeration Date	:	05/20/2006
Last Update Date	:	07/19/2007

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