Provider Demographics
NPI:1487729307
Name:TENDER HEART ADULT DAY HEALTH CARE
Entity type:Organization
Organization Name:TENDER HEART ADULT DAY HEALTH CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:NELLY
Authorized Official - Middle Name:SUPAPO
Authorized Official - Last Name:LIZASO
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:760-244-8776
Mailing Address - Street 1:9499 I AVE
Mailing Address - Street 2:
Mailing Address - City:HESPERIA
Mailing Address - State:CA
Mailing Address - Zip Code:92345-6282
Mailing Address - Country:US
Mailing Address - Phone:760-244-8776
Mailing Address - Fax:760-244-9456
Practice Address - Street 1:9499 I AVE
Practice Address - Street 2:
Practice Address - City:HESPERIA
Practice Address - State:CA
Practice Address - Zip Code:92345-6282
Practice Address - Country:US
Practice Address - Phone:760-244-8776
Practice Address - Fax:760-244-9456
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA261QA0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAADU70199FOtherADULT DAY HEALTH CARE