MEDICARE: TENDER LOVING CARE SERVICES OF GEORGIA, L.L.C.

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	060-286	GA

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	:	1710133749
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TENDER LOVING CARE SERVICES OF GEORGIA, L.L.C.

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	:	225-292-2031
Fax Number	:	225-295-9678

Provider Business Practice Location Address
First Line	:	2310 PARKLAKE DR NE
Second Line	:	SUITE 350
City	:	ATLANTA
State	:	GA
Zip	:	30345-2913
Country	:	US
Telephone Number	:	710-938-5795
Fax Number	:	770-496-0624

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

Provider Enumeration Date	:	08/11/2008
Last Update Date	:	08/19/2010

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