Provider Demographics
NPI:1912540774
Name:TDLSS LLC
Entity Type:Organization
Organization Name:TDLSS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SHELBY
Authorized Official - Middle Name:
Authorized Official - Last Name:QUINNETTE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-957-8331
Mailing Address - Street 1:36520 GRAND RIVER AVE STE 103
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48335-3014
Mailing Address - Country:US
Mailing Address - Phone:248-957-8331
Mailing Address - Fax:
Practice Address - Street 1:36520 GRAND RIVER AVE STE 103
Practice Address - Street 2:
Practice Address - City:FARMINGTON HILLS
Practice Address - State:MI
Practice Address - Zip Code:48335-3014
Practice Address - Country:US
Practice Address - Phone:248-957-8331
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-24
Last Update Date:2019-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health