Provider Demographics
NPI:1427447333
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:MR
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 1:2344 E CAMINO MALCOTE
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85706-5191
Mailing Address - Country:US
Mailing Address - Phone:520-981-5227
Mailing Address - Fax:520-886-1413
Practice Address - Street 1:7232 E MONTECITO DR
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85710-4922
Practice Address - Country:US
Practice Address - Phone:520-546-1724
Practice Address - Fax:520-886-1413
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-15
Last Update Date:2015-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZBH4550320800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness