Healthcare Provider Details

I. General information

NPI: 1700401593
Provider Name (Legal Business Name): TDC HOME CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/08/2020
Last Update Date: 02/16/2023
Certification Date: 02/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1031 SUMMIT AVE STE S-4
GREENSBORO NC
27405-7010
US

IV. Provider business mailing address

PO BOX 5016
GREENSBORO NC
27435-0016
US

V. Phone/Fax

Practice location:
  • Phone: 336-456-2370
  • Fax:
Mailing address:
  • Phone: 336-456-2370
  • Fax: 336-763-5065

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State

VIII. Authorized Official

Name: MS. TINA ROCHELL MEBANE
Title or Position: DIRECTOR
Credential:
Phone: 336-456-2370