Basic Information
| Provider Information | |||||||||
| NPI: | 1922439272 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | TENDERCARE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 22950 NORTHLINE RD | ||||||||
| Address2: | |||||||||
| City: | TAYLOR | ||||||||
| State: | MI | ||||||||
| PostalCode: | 481804696 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7342871230 | ||||||||
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| Practice Location | |||||||||
| Address1: | 19300 WHERLE DR | ||||||||
| Address2: | |||||||||
| City: | BROWNSTOWN | ||||||||
| State: | MI | ||||||||
| PostalCode: | 481938530 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3136716231 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 12/11/2013 | ||||||||
| LastUpdateDate: | 12/11/2013 | ||||||||
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| AuthorizedOfficialLastName: | HALL | ||||||||
| AuthorizedOfficialFirstName: | KIMBERLY | ||||||||
| AuthorizedOfficialMiddleName: | ANN | ||||||||
| AuthorizedOfficialTitleorPosition: | CERTIFIED OCCUPATIONAL THERAPY ASST | ||||||||
| AuthorizedOfficialTelephone: | 3136716231 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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| AuthorizedOfficialCredential: | COTA/L | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 314000000X | MI | Y | Nursing & Custodial Care Facilities | Skilled Nursing Facility |
ID Information
| ID | Type | State | Issuer | Description | 5202002761 | 01 | MI | BOARD OF OCCUPATIONAL THERAPIST OCCUPATIONAL THERAPY ASSISTANT LICENSE | OTHER |