Basic Information
| Provider Information | |||||||||
| NPI: | 1427002591 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | TENDER LOVING CARE HEALTH CARE SERVICES OF DADE, LLC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | STAFF BUILDERS HOME HEALTH | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5959 S SHERWOOD FOREST BLVD | ||||||||
| Address2: | |||||||||
| City: | BATON ROUGE | ||||||||
| State: | LA | ||||||||
| PostalCode: | 708166038 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2252983548 | ||||||||
| FaxNumber: | 2252959678 | ||||||||
| Practice Location | |||||||||
| Address1: | 15495 EAGLE NEST LN | ||||||||
| Address2: | STE 260 | ||||||||
| City: | MIAMI LAKES | ||||||||
| State: | FL | ||||||||
| PostalCode: | 330142242 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3053652050 | ||||||||
| FaxNumber: | 3058229415 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/21/2006 | ||||||||
| LastUpdateDate: | 10/15/2009 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | BORNE | ||||||||
| AuthorizedOfficialFirstName: | WILLIAM | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 2252922031 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | TLC HEALTH CARE SERVICES, INC. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251E00000X | 2113096 | FL | Y | Agencies | Home Health |
ID Information
| ID | Type | State | Issuer | Description | 201031840003 | 01 | FL | TRICARE HUMANA | OTHER | 651112900 | 05 | FL | MEDICAID | 107129 | 01 | FL | HUMANA PPS | OTHER |