Basic Information
| Provider Information | |||||||||
| NPI: | 1396040614 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | TDMK, LLC | ||||||||
| LastName: | |||||||||
| FirstName: | |||||||||
| MiddleName: | |||||||||
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| Credential: | |||||||||
| OtherOrganizationName: | ALL CARE HEALTH SOLUTIONS | ||||||||
| OtherOrganizationType: | 3 | ||||||||
| OtherLastName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 815 S BRIDGE WAY PL | ||||||||
| Address2: | SUITE 122 | ||||||||
| City: | EAGLE | ||||||||
| State: | ID | ||||||||
| PostalCode: | 836166006 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2084732717 | ||||||||
| FaxNumber: | 8778905617 | ||||||||
| Practice Location | |||||||||
| Address1: | 815 S BRIDGE WAY PL | ||||||||
| Address2: | SUITE 122 | ||||||||
| City: | EAGLE | ||||||||
| State: | ID | ||||||||
| PostalCode: | 836166006 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2084732717 | ||||||||
| FaxNumber: | 8778905617 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/18/2011 | ||||||||
| LastUpdateDate: | 09/13/2013 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | HILLESHIEM | ||||||||
| AuthorizedOfficialFirstName: | ANGELA | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | OWNER/ADMINISTRATOR | ||||||||
| AuthorizedOfficialTelephone: | 2084732717 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | R.N. | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251E00000X | HH-253 | ID | Y | Agencies | Home Health |
No ID Information.