Provider Demographics
NPI:1871750018
Name:TENDER CARE HOME HEALTH CARE LLC
Entity type:Organization
Organization Name:TENDER CARE HOME HEALTH CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:DARRELL
Authorized Official - Middle Name:KENYATTA
Authorized Official - Last Name:TENNIE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:843-669-0104
Mailing Address - Street 1:3005 VILLAGE PARK DR
Mailing Address - Street 2:SUITE 204 B
Mailing Address - City:KNIGHTDALE
Mailing Address - State:NC
Mailing Address - Zip Code:27545-7993
Mailing Address - Country:US
Mailing Address - Phone:843-669-0104
Mailing Address - Fax:843-629-0325
Practice Address - Street 1:1245 CELEBRATION BLVD
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:SC
Practice Address - Zip Code:29501-5499
Practice Address - Country:US
Practice Address - Phone:843-669-0104
Practice Address - Fax:843-629-0325
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-16
Last Update Date:2023-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCEX0784Medicaid