Provider Demographics
NPI:1194280479
Name:TENDER LOVING CARE HOME LLC
Entity type:Organization
Organization Name:TENDER LOVING CARE HOME LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ASSISTANT ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:PASCAL
Authorized Official - Middle Name:AMINKENG
Authorized Official - Last Name:ETIENDEM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:520-981-5227
Mailing Address - Street 1:7232 E MONTECITO DR
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85710-4922
Mailing Address - Country:US
Mailing Address - Phone:520-250-7898
Mailing Address - Fax:520-771-9592
Practice Address - Street 1:509 S STAUNTON DR
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85710-6254
Practice Address - Country:US
Practice Address - Phone:520-250-7898
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-31
Last Update Date:2019-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness