Provider Demographics
NPI:1124279401
Name:TENDER CARE TRANSPORT, INC
Entity type:Organization
Organization Name:TENDER CARE TRANSPORT, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:GUY
Authorized Official - Middle Name:R
Authorized Official - Last Name:WOOD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:715-835-2435
Mailing Address - Street 1:1592 118TH STREET
Mailing Address - Street 2:
Mailing Address - City:CHIPPEWA FALLS
Mailing Address - State:WI
Mailing Address - Zip Code:54729-5572
Mailing Address - Country:US
Mailing Address - Phone:715-835-2435
Mailing Address - Fax:715-835-1400
Practice Address - Street 1:1592 118TH STREET
Practice Address - Street 2:
Practice Address - City:CHIPPEWA FALLS
Practice Address - State:WI
Practice Address - Zip Code:54729-5572
Practice Address - Country:US
Practice Address - Phone:715-835-2435
Practice Address - Fax:715-835-1400
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-06
Last Update Date:2008-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI41425500Medicaid