Basic Information
Provider Information | |||||||||
NPI: | 1407800584 | ||||||||
EntityType: | 2 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: | TENDER LOVING CARE HEALTH CARE SERVICES OF NEW ENGLAND , LLC | ||||||||
LastName: |   | ||||||||
FirstName: |   | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: |   | ||||||||
OtherOrganizationName: | AMEDISYS HOME HEALTH CARE | ||||||||
OtherOrganizationType: | 3 | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 3854 AMERICAN WAY | ||||||||
Address2: | SUITE A | ||||||||
City: | BATON ROUGE | ||||||||
State: | LA | ||||||||
PostalCode: | 708164013 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 2252922031 | ||||||||
FaxNumber: | 2252959678 | ||||||||
Practice Location | |||||||||
Address1: | 290 MERRIMACK ST STE 241 | ||||||||
Address2: |   | ||||||||
City: | LAWRENCE | ||||||||
State: | MA | ||||||||
PostalCode: | 018431782 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 9786852818 | ||||||||
FaxNumber: | 9787385071 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 05/21/2006 | ||||||||
LastUpdateDate: | 05/09/2018 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: |   | ||||||||
AuthorizedOfficialLastName: | KUSSEROW | ||||||||
AuthorizedOfficialFirstName: | PAUL | ||||||||
AuthorizedOfficialMiddleName: | B | ||||||||
AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
AuthorizedOfficialTelephone: | 2252922031 | ||||||||
IsSoleProprietor: |   | ||||||||
IsOrganizationSubpart: | N | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251E00000X |   |   | Y |   | Agencies | Home Health |   |
ID Information
ID | Type | State | Issuer | Description | 0608416 | 05 | MA |   | MEDICAID | 120211 | 01 | MA | MASSACUUSETTS BC BS OF MA | OTHER | 110080794B | 05 | MA |   | MEDICAID | 0608416 | 01 | MA | MA MCD INTERMITTENT | OTHER | 201031840015 | 01 | MA | TRICARE HEALTH NET | OTHER | 60 00332 | 01 | MA | EVERCARE | OTHER |