Provider Demographics
NPI:1942821145
Name:TDS HEALTH HOME CARE LLC
Entity Type:Organization
Organization Name:TDS HEALTH HOME CARE LLC
Other - Org Name:TDS HEALTH HOME CARE LLC
Other - Org Type:Other Name
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:STELLA
Authorized Official - Middle Name:N
Authorized Official - Last Name:KINTU
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD, RPH, BCMCMS
Authorized Official - Phone:703-398-8525
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:703-398-8525
Mailing Address - Fax:571-659-9028
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:703-398-8525
Practice Address - Fax:571-659-9028
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TDS HEALTH INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-04-29
Last Update Date:2020-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2278G0305XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, CertifiedGeriatric CareGroup - Multi-Specialty
Yes251E00000XAgenciesHome HealthGroup - Multi-Specialty
No374U00000XNursing Service Related ProvidersHome Health AideGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1467975565Medicaid