Basic Information
| Provider Information | |||||||||
| NPI: | 1326498601 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | A TENDER LOVE AND CARE INC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | FAMILY MATTERS COUNSELING SERVICES | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 12968 FREDERICK ST STE D | ||||||||
| Address2: | |||||||||
| City: | MORENO VALLEY | ||||||||
| State: | CA | ||||||||
| PostalCode: | 925535229 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9512427738 | ||||||||
| FaxNumber: | 9512427733 | ||||||||
| Practice Location | |||||||||
| Address1: | 12968 FREDERICK ST STE ABC&D | ||||||||
| Address2: | |||||||||
| City: | MORENO VALLEY | ||||||||
| State: | CA | ||||||||
| PostalCode: | 925535229 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9516623010 | ||||||||
| FaxNumber: | 9512427733 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/16/2016 | ||||||||
| LastUpdateDate: | 10/31/2016 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
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| AuthorizedOfficialLastName: | SABOOWALA | ||||||||
| AuthorizedOfficialFirstName: | HUZAIFA | ||||||||
| AuthorizedOfficialMiddleName: | MOIZ | ||||||||
| AuthorizedOfficialTitleorPosition: | EXECUTIVE DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 9516623010 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | A TENDER LOVE AND CARE INC. | ||||||||
| AuthorizedOfficialNamePrefix: | MR. | ||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | B.E | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 305R00000X | 336425454 | CA | Y | Managed Care Organizations | Preferred Provider Organization |
No ID Information.