MEDICARE: TENDER LOVING CARE HEALTH CARE SERVICES OF DADE, 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	2113096	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	201031840003	OTHER	FL	TRICARE HUMANA
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	107129	OTHER	FL	HUMANA PPS

General Provider Information

NPI Number	:	1427002591
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TENDER LOVING CARE HEALTH CARE SERVICES OF DADE, LLC

Provider Business Mailing Address
First Line	:	5959 S SHERWOOD FOREST BLVD
Second Line	:
City	:	BATON ROUGE
State	:	LA
Zip	:	70816-6038
Country	:	US
Telephone Number	:	225-298-3548
Fax Number	:	225-295-9678

Provider Business Practice Location Address
First Line	:	15495 EAGLE NEST LN
Second Line	:	STE 260
City	:	MIAMI LAKES
State	:	FL
Zip	:	33014-2242
Country	:	US
Telephone Number	:	305-365-2050
Fax Number	:	305-822-9415

Authorized Official
Title or Position	:	CEO
Name	:	WILLIAM BORNE
Credential	:
Telephone Number	:	225-292-2031

Provider Enumeration Date	:	05/21/2006
Last Update Date	:	10/15/2009

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