- Enrollment id
- O20110721000794
- Enrollment state
- ID
- Provider type code
- 00-06
- Provider type text
- PART A PROVIDER - HOME HEALTH AGENCY
- Npi
- 1396040614
- Multiple npi flag
- N
- Ccn
- 137121
- Associate id
- 3476721275
- Organization name
- TDMK, LLC
- Doing business as name
- ALL CARE HEALTH SOLUTIONS
- Incorporation date
- 2009-10-28
- Incorporation state
- ID
- Organization type structure
- LLC
- Proprietary nonprofit
- P
- Address line 1
- 815 S BRIDGEWAY PL
- Address line 2
- STE 122
- City
- EAGLE
- State
- ID
- Zip code
- 836166022