Provider Demographics
NPI:1851861991
Name:TDAL HOME CARE LLC
Entity Type:Organization
Organization Name:TDAL HOME CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:HAROLD
Authorized Official - Middle Name:
Authorized Official - Last Name:BRAGGS
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:313-461-7836
Mailing Address - Street 1:19510 BURLINGTON DR
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48203-1454
Mailing Address - Country:US
Mailing Address - Phone:313-461-7836
Mailing Address - Fax:
Practice Address - Street 1:19510 BURLINGTON DR
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48203-1454
Practice Address - Country:US
Practice Address - Phone:313-461-7836
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-12-02
Last Update Date:2018-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care AttendantGroup - Multi-Specialty
No3747A0650XNursing Service Related ProvidersTechnicianAttendant Care ProviderGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI802224649OtherSTATE ID