MEDICARE: TENDER LOVING CARE MEDICAL SOCIAL WORKER AGENCY, INC.

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	251B00000X	Case Management Agency	65069	CA
2	251S00000X	Community/Behavioral Health Agency	65069	CA

General Provider Information

NPI Number	:	1629382270
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TENDER LOVING CARE MEDICAL SOCIAL WORKER AGENCY, INC.

Provider Business Mailing Address
First Line	:	400 CORPORATE POINTE
Second Line	:	SUITE 300
City	:	CULVER CITY
State	:	CA
Zip	:	90230-7615
Country	:	US
Telephone Number	:	424-750-3133
Fax Number	:	424-750-3135

Provider Business Practice Location Address
First Line	:	400 CORPORATE POINTE
Second Line	:	SUITE 300
City	:	CULVER CITY
State	:	CA
Zip	:	90230-7615
Country	:	US
Telephone Number	:	424-750-3133
Fax Number	:	424-750-3135

Authorized Official
Title or Position	:	CHIEF EXECUTIVE OFFICER
Name	:	MS. YVETTE ANTOINETTE JACKSON
Credential	:	LCSW
Telephone Number	:	323-253-9780

Provider Enumeration Date	:	08/05/2010
Last Update Date	:	03/23/2016

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