Provider Demographics
NPI:1215981394
Name:TENDEDR LOVING CARE HEALTH CARE SERVICES OF PA, LLC
Entity type:Organization
Organization Name:TENDEDR LOVING CARE HEALTH CARE SERVICES OF PA, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:WILLARD
Authorized Official - Middle Name:T
Authorized Official - Last Name:DERR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:516-358-1000
Mailing Address - Street 1:1983 MARCUS AVE
Mailing Address - Street 2:STE 200
Mailing Address - City:LAKE SUCCESS
Mailing Address - State:NY
Mailing Address - Zip Code:11042-1016
Mailing Address - Country:US
Mailing Address - Phone:516-358-1000
Mailing Address - Fax:516-327-8636
Practice Address - Street 1:401 COMMERCE DR
Practice Address - Street 2:2ND FL
Practice Address - City:FT WASHINGTON
Practice Address - State:PA
Practice Address - Zip Code:19034-2714
Practice Address - Country:US
Practice Address - Phone:215-646-9401
Practice Address - Fax:215-646-9543
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TLC HEALTH CARE SERVICES, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-05-21
Last Update Date:2007-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA756705251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA30022841OtherPA KEYSTONE MERCY HEALTH
PA1014935910002Medicaid
PA1014935910002Medicaid