Provider Demographics
NPI:1942666243
Name:TDE ELDERLY ASSISTANCE SERVICES, LLC
Entity Type:Organization
Organization Name:TDE ELDERLY ASSISTANCE SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TERESA
Authorized Official - Middle Name:DIANNE
Authorized Official - Last Name:ELDRIDGE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:321-557-5017
Mailing Address - Street 1:300 QUAIL DR
Mailing Address - Street 2:
Mailing Address - City:MERRITT ISLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32953-4674
Mailing Address - Country:US
Mailing Address - Phone:321-557-5017
Mailing Address - Fax:321-452-1385
Practice Address - Street 1:300 QUAIL DR
Practice Address - Street 2:
Practice Address - City:MERRITT ISLAND
Practice Address - State:FL
Practice Address - Zip Code:32953-4674
Practice Address - Country:US
Practice Address - Phone:321-557-5017
Practice Address - Fax:321-452-1385
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-04
Last Update Date:2016-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL234010253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care