Provider Demographics
NPI:1366767022
Name:TENDER LOVE NURSING CARE
Entity type:Organization
Organization Name:TENDER LOVE NURSING CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXEC. DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DEANNA
Authorized Official - Middle Name:CLAUDETTE
Authorized Official - Last Name:MOORE
Authorized Official - Suffix:
Authorized Official - Credentials:CCC/SLP
Authorized Official - Phone:478-714-1040
Mailing Address - Street 1:328 AUDREY WAY
Mailing Address - Street 2:
Mailing Address - City:KATHLEEN
Mailing Address - State:GA
Mailing Address - Zip Code:31047-2166
Mailing Address - Country:US
Mailing Address - Phone:478-714-1040
Mailing Address - Fax:
Practice Address - Street 1:4501 RUSSELL PKWY STE 1CR
Practice Address - Street 2:
Practice Address - City:WARNER ROBINS
Practice Address - State:GA
Practice Address - Zip Code:31088-8678
Practice Address - Country:US
Practice Address - Phone:478-714-1040
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-06
Last Update Date:2010-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GASLP004692235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty