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General NPI Number Information
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NPI Number | 1942666243
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Entity Type | Organization
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Legal Business Name | TDE ELDERLY ASSISTANCE SERVICES, LLC
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Dates
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Enumeration Date | 01/04/2016
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Last Update Date | 01/04/2016
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Provider Practice Location Address
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Address Line | 300 QUAIL DR
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City | MERRITT ISLAND
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State | FL
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Zip | 32953-4674
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Country | US
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Telephone | 321-557-5017
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Fax | 321-452-1385
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Provider Business Mailing Address
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Address Line | 300 QUAIL DR
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City | MERRITT ISLAND
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State | FL
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Zip | 32953-4674
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Country | US
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Telephone | 321-557-5017
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Fax | 321-452-1385
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Authorized Official
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Title or Position | OWNER
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Name | TERESA DIANNE ELDRIDGE
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Credential |
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Telephone | 321-557-5017
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number | 234010
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License Number State | FL
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