Healthcare Provider Details

I. General information

NPI: 1942821145
Provider Name (Legal Business Name): TDS HEALTH HOME CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/29/2020
Last Update Date: 05/07/2020
Certification Date: 05/07/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4215 DALE BLVD
WOODBRIDGE VA
22193-2243
US

IV. Provider business mailing address

4215 DALE BLVD
WOODBRIDGE VA
22193-2243
US

V. Phone/Fax

Practice location:
  • Phone: 703-398-8525
  • Fax: 571-659-9028
Mailing address:
  • Phone: 703-398-8525
  • Fax: 571-659-9028

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 Code374U00000X
TaxonomyHome Health Aide
License Number
License Number State

VIII. Authorized Official

Name: DR. STELLA N KINTU
Title or Position: CEO
Credential: PHARMD, RPH, BCMCMS
Phone: 703-398-8525