Provider Demographics
NPI:1043264112
Name:TENDER LOVING CARE HEALTH CARE SERVICES OF NEW ENGLAND, LLC
Entity type:Organization
Organization Name:TENDER LOVING CARE HEALTH CARE SERVICES OF NEW ENGLAND, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:KUSSEROW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:225-292-2031
Mailing Address - Street 1:3854 AMERICAN WAY
Mailing Address - Street 2:SUITE A
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70816-4013
Mailing Address - Country:US
Mailing Address - Phone:225-292-2031
Mailing Address - Fax:225-295-9678
Practice Address - Street 1:68 SOUTHFIELD AVE
Practice Address - Street 2:SUITE 215
Practice Address - City:STAMFORD
Practice Address - State:CT
Practice Address - Zip Code:06902-7237
Practice Address - Country:US
Practice Address - Phone:203-327-2680
Practice Address - Fax:203-327-3932
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TLC HEALTH CARE SERVICES, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-05-21
Last Update Date:2016-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251B00000X, 374U00000X
CT0016251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251E00000XAgenciesHome Health
No251B00000XAgenciesCase ManagementGroup - Multi-Specialty
No374U00000XNursing Service Related ProvidersHome Health AideGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT644OtherANTHEM BLUE CROSS BLUE SH
CTCHN49927OtherCT COMMUNITY HEALTH NETWO
CT004248036Medicaid
CT004249349Medicaid
CT004248135Medicaid
CTN278795OtherFIRST CHOICE HEALTH PLAN
CTANC213OtherOXFORD
CTN278795OtherWELLCARE HMO
CT644OtherCT BLUE CROSS BLUE SHEILD
CT1000034054OtherTENET CHOICES
CTN278795OtherFIRST CHOICE HEALTH PLAN