Provider Demographics
NPI:1861527723
Name:TENDER LOVING CARE HEALTH CARE SERVICES OF WEST VIRGINIA, LLC
Entity type:Organization
Organization Name:TENDER LOVING CARE HEALTH CARE SERVICES OF WEST VIRGINIA, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:F
Authorized Official - Last Name:BORNE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:225-292-2031
Mailing Address - Street 1:5959 S SHERWOOD FOREST BLVD
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70816-6038
Mailing Address - Country:US
Mailing Address - Phone:225-292-2031
Mailing Address - Fax:225-295-9678
Practice Address - Street 1:1231 WARWOOD AVE
Practice Address - Street 2:SUITE B
Practice Address - City:WHEELING
Practice Address - State:WV
Practice Address - Zip Code:26003-7129
Practice Address - Country:US
Practice Address - Phone:304-277-1500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TENDER LOVING CARE HEALTH CARE SERVICES OF WEST VIRGINIA, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-02-22
Last Update Date:2010-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3810003458Medicaid