Provider Demographics
NPI:1215976436
Name:TENDER LOVING CARE HEALTH CARE SERVICES SOUTHEAST, LLC
Entity type:Organization
Organization Name:TENDER LOVING CARE HEALTH CARE SERVICES SOUTHEAST, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VP TAX
Authorized Official - Prefix:
Authorized Official - First Name:TRAVIS
Authorized Official - Middle Name:
Authorized Official - Last Name:MIGLICCO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:225-299-3803
Mailing Address - Street 1:3854 AMERICAN WAY
Mailing Address - Street 2:SUITE A
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70816-4013
Mailing Address - Country:US
Mailing Address - Phone:225-292-2031
Mailing Address - Fax:225-295-9678
Practice Address - Street 1:3320 US 1 HWY
Practice Address - Street 2:SUITE B
Practice Address - City:FRANKLINTON
Practice Address - State:NC
Practice Address - Zip Code:27525-8439
Practice Address - Country:US
Practice Address - Phone:919-494-3773
Practice Address - Fax:919-249-4258
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-05
Last Update Date:2024-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCHOS3147251G00000X
NCHOS3826251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0000AOtherNC BCBS HOSPICE
NC1215976436Medicaid
NC3421560Medicaid
NC3421560Medicaid