MEDICARE: TDX5 LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251G00000X	Community Based Hospice Care Agency

General Provider Information

NPI Number	:	1215635511
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TDX5 LLC

Provider Business Mailing Address
First Line	:	124 N SENECA SPRINGS WAY STE B
Second Line	:
City	:	STAR
State	:	ID
Zip	:	83669-6037
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	124 N SENECA SPRINGS WAY STE B
Second Line	:
City	:	STAR
State	:	ID
Zip	:	83669-6037
Country	:	US
Telephone Number	:	208-629-1037
Fax Number	:	208-629-1513

Authorized Official
Title or Position	:	RN/DCS/CEO
Name	:	MRS. TRUDY HAGLER
Credential	:
Telephone Number	:	208-606-2745

Provider Enumeration Date	:	02/16/2023
Last Update Date	:	08/21/2025

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Directions to “TDX5 LLC ” Practice Location

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