Provider Demographics
NPI:1215635511
Name:TDX5 LLC
Entity type:Organization
Organization Name:TDX5 LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RN/DCS/CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:TRUDY
Authorized Official - Middle Name:
Authorized Official - Last Name:HAGLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:775-223-1434
Mailing Address - Street 1:124 N SENECA SPRINGS WAY STE B
Mailing Address - Street 2:
Mailing Address - City:STAR
Mailing Address - State:ID
Mailing Address - Zip Code:83669-6037
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:124 N SENECA SPRINGS WAY STE B
Practice Address - Street 2:
Practice Address - City:STAR
Practice Address - State:ID
Practice Address - Zip Code:83669-6037
Practice Address - Country:US
Practice Address - Phone:772-223-1434
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-16
Last Update Date:2023-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based