Provider Demographics
NPI:1679269930
Name:TDS HEALTH
Entity Type:Organization
Organization Name:TDS HEALTH
Other - Org Name:TDS HEALTH GROUP HOMES
Other - Org Type:Other Name
Authorized Official - Title/Position:DIRECTOR/ AUTHORIZED OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:STELLA
Authorized Official - Middle Name:N
Authorized Official - Last Name:KINTU
Authorized Official - Suffix:
Authorized Official - Credentials:PHARM D
Authorized Official - Phone:703-457-1049
Mailing Address - Street 1:4215 DALE BLVD
Mailing Address - Street 2:
Mailing Address - City:WOODBRIDGE
Mailing Address - State:VA
Mailing Address - Zip Code:22193-2243
Mailing Address - Country:US
Mailing Address - Phone:703-457-1049
Mailing Address - Fax:
Practice Address - Street 1:4215 DALE BLVD
Practice Address - Street 2:
Practice Address - City:WOODBRIDGE
Practice Address - State:VA
Practice Address - Zip Code:22193-2243
Practice Address - Country:US
Practice Address - Phone:703-457-1049
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TDS HEALTH
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-04-11
Last Update Date:2023-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TM1800XBehavioral Health & Social Service ProvidersPsychologistIntellectual & Developmental DisabilitiesGroup - Single Specialty