Provider Demographics
NPI:1346564432
Name:TDAF,LLC
Entity Type:Organization
Organization Name:TDAF,LLC
Other - Org Name:JOHNSON HOMES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DAVE
Authorized Official - Middle Name:ALLEN
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:LNFA, LBSW
Authorized Official - Phone:432-413-1425
Mailing Address - Street 1:PO BOX 27
Mailing Address - Street 2:
Mailing Address - City:GOLDTHWAITE
Mailing Address - State:TX
Mailing Address - Zip Code:76844-0027
Mailing Address - Country:US
Mailing Address - Phone:325-985-3544
Mailing Address - Fax:325-985-3575
Practice Address - Street 1:210 COUNTY ROAD 112
Practice Address - Street 2:
Practice Address - City:GOLDTHWAITE
Practice Address - State:TX
Practice Address - Zip Code:76844-3701
Practice Address - Country:US
Practice Address - Phone:325-985-3544
Practice Address - Fax:325-985-3575
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-18
Last Update Date:2010-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes315P00000XNursing & Custodial Care FacilitiesIntermediate Care Facility, Intellectual Disabilities