Organization
TDA INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JESSI ERIN ECKLEY (PRESIDENT)
(208) 463-9464
Entity
Organization
Contact information
Practice address
524 E LOCUST LN, NAMPA, ID 83686-8415
(208) 463-9464
(208) 463-9464
Mailing address
524 E LOCUST LN, NAMPA, ID 83686-8415
(208) 463-9464
(208) 463-9464
Taxonomy
Speciality
Code
Description
License number
State
251E00000X
Home Health Agency
Primary
808110900
ID
251E00000X
Home Health Agency
808110901
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
808110900
—
ID
05
—
808110901
—
ID
Enumeration date
08/12/2008
Last updated
08/27/2008
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