Provider Demographics
NPI:1487804209
Name:TENDER LOVING CARE HEALTH CARE SERVICES OF MICHIGAN, L.L.C.
Entity type:Organization
Organization Name:TENDER LOVING CARE HEALTH CARE SERVICES OF MICHIGAN, L.L.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:BORNE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:225-292-2031
Mailing Address - Street 1:5959 S SHERWOOD FOREST BLVD
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70816-6038
Mailing Address - Country:US
Mailing Address - Phone:225-292-2031
Mailing Address - Fax:225-298-3548
Practice Address - Street 1:7457 M E CAD BLVD
Practice Address - Street 2:SUITE 200
Practice Address - City:CLARKSTON
Practice Address - State:MI
Practice Address - Zip Code:48348-4282
Practice Address - Country:US
Practice Address - Phone:248-620-0066
Practice Address - Fax:248-620-0011
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TENDER LOVING CARE HEALTH CARE SERVICES OF MICHIGAN, L.L.C.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-09-29
Last Update Date:2009-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1487804209Medicaid
MI1487804209Medicaid