Provider Demographics
NPI:1194068221
Name:TENDER AT HEART ASSISTED LIVING FACILITY INC
Entity type:Organization
Organization Name:TENDER AT HEART ASSISTED LIVING FACILITY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:JENNY-ANN
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:321-327-2936
Mailing Address - Street 1:1773 HAYS ST NW
Mailing Address - Street 2:
Mailing Address - City:PALM BAY
Mailing Address - State:FL
Mailing Address - Zip Code:32907-7115
Mailing Address - Country:US
Mailing Address - Phone:321-327-2936
Mailing Address - Fax:321-821-4626
Practice Address - Street 1:1773 HAYS ST NW
Practice Address - Street 2:
Practice Address - City:PALM BAY
Practice Address - State:FL
Practice Address - Zip Code:32907-7115
Practice Address - Country:US
Practice Address - Phone:321-327-2936
Practice Address - Fax:321-821-4626
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-27
Last Update Date:2013-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL12260310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL006637200Medicaid