MEDICARE: TENDER HEART HOME HEALTH, 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	005005	TX

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	:	1578521258
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TENDER HEART HOME HEALTH, LLC

Provider Business Mailing Address
First Line	:	3210 W PARK ROW DR
Second Line	:
City	:	PANTEGO
State	:	TX
Zip	:	76013-3153
Country	:	US
Telephone Number	:	817-265-0066
Fax Number	:	817-265-0089

Provider Business Practice Location Address
First Line	:	3210 W PARK ROW DR
Second Line	:
City	:	PANTEGO
State	:	TX
Zip	:	76013-3136
Country	:	US
Telephone Number	:	817-265-0066
Fax Number	:	817-265-0089

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MRS. KOFO KAY SERIKI
Credential	:	MPA
Telephone Number	:	817-265-0066

Provider Enumeration Date	:	05/03/2006
Last Update Date	:	01/16/2012

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Directions to “TENDER HEART HOME HEALTH, LLC ” Practice Location

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