Provider Demographics
NPI:1053590786
Name:QUEEN TENDER CARE
Entity type:Organization
Organization Name:QUEEN TENDER CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:HERVIANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:FONROSE
Authorized Official - Suffix:
Authorized Official - Credentials:CNA
Authorized Official - Phone:732-361-3113
Mailing Address - Street 1:1333 EMBURY AVE
Mailing Address - Street 2:
Mailing Address - City:NEPTUNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07753-5041
Mailing Address - Country:US
Mailing Address - Phone:732-361-3113
Mailing Address - Fax:732-359-6210
Practice Address - Street 1:901 3RD AVE
Practice Address - Street 2:
Practice Address - City:ASBURY PARK
Practice Address - State:NJ
Practice Address - Zip Code:07712-5803
Practice Address - Country:US
Practice Address - Phone:732-361-3113
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-30
Last Update Date:2007-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJHP0105300251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health