Provider Demographics
NPI:1558745349
Name:TDS CARE SERVICES
Entity Type:Organization
Organization Name:TDS CARE SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JEANNETTE
Authorized Official - Middle Name:LOVETTE
Authorized Official - Last Name:MINGO
Authorized Official - Suffix:
Authorized Official - Credentials:CNA
Authorized Official - Phone:704-421-1684
Mailing Address - Street 1:349 COPPERFIELD BLVD NE STE L 336
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:NC
Mailing Address - Zip Code:28025-2432
Mailing Address - Country:US
Mailing Address - Phone:704-421-1684
Mailing Address - Fax:
Practice Address - Street 1:2706 DAWSON DR APT 165
Practice Address - Street 2:
Practice Address - City:CHESTER
Practice Address - State:SC
Practice Address - Zip Code:29706-5225
Practice Address - Country:US
Practice Address - Phone:704-421-1684
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-13
Last Update Date:2015-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC7749269251B00000X, 251E00000X, 251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No251B00000XAgenciesCase Management
No251E00000XAgenciesHome Health