Provider Demographics
NPI:1194274829
Name:TENDER CARE TRANSPORT LLC
Entity type:Organization
Organization Name:TENDER CARE TRANSPORT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:BERNITA
Authorized Official - Middle Name:
Authorized Official - Last Name:BENNETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:478-951-4048
Mailing Address - Street 1:1223 POLK XING
Mailing Address - Street 2:
Mailing Address - City:MCDONOUGH
Mailing Address - State:GA
Mailing Address - Zip Code:30252-8070
Mailing Address - Country:US
Mailing Address - Phone:478-951-4048
Mailing Address - Fax:478-352-0004
Practice Address - Street 1:725 MAGNOLIA DR
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31217-4139
Practice Address - Country:US
Practice Address - Phone:478-951-4048
Practice Address - Fax:478-352-0004
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-22
Last Update Date:2016-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARAU2233343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA1001182OtherMACON-BIBB COUNTY BUSINESS LICENSE