MEDICARE: TENDER LOVE AND CARE STAFFING AGENCY 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	311Z00000X	Custodial Care Facility	PCA7010	LA

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
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1902073943
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TENDER LOVE AND CARE STAFFING AGENCY LLC

Provider Business Mailing Address
First Line	:	11628 S CHOCTAW DR STE 219
Second Line	:
City	:	BATON ROUGE
State	:	LA
Zip	:	70815-2107
Country	:	US
Telephone Number	:	225-273-6224
Fax Number	:

Provider Business Practice Location Address
First Line	:	11628 S CHOCTAW DR STE 219
Second Line	:
City	:	BATON ROUGE
State	:	LA
Zip	:	70815-2107
Country	:	US
Telephone Number	:	225-273-6224
Fax Number	:

Authorized Official
Title or Position	:	CFO
Name	:	VERNITA HARDY
Credential	:	RN
Telephone Number	:	225-273-6224

Provider Enumeration Date	:	05/09/2008
Last Update Date	:	05/09/2008

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Directions to “TENDER LOVE AND CARE STAFFING AGENCY LLC ” Practice Location

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