Tdiii,Inc
Organization Active NPI Assisted Living Facility (Mental Illness) · Crane, MO
NPI 1730219973 · NPPES record last updated Aug 22, 2020
Key facts
- NPI
- 1730219973
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Assisted Living Facility (Mental Illness) 3104A0625X
- License
- 033564 (MO)
- Legal business name
- TDIII,INC
- Practice address
- 102 E Lillian Ave
Crane, MO 65633-9103 - Phone
- (417) 723-5900
- Fax
- (417) 723-8559
- NPI assigned
- Mar 6, 2007
- Organization subpart
- No
Authorized official
- Name
- Mr. Troy Hall Davidson III
- Title
- Ceo
- Phone
- (417) 890-8172
Practitioners 2
-
Tammy Jo Brazeal, PH.D.
-
Rose M Butler, DPM
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 26D0957816 | Crane Residential Care Home | Certificate of waiver | Mar 2, 2027 |
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Assisted Living Facility (Mental Illness) | 3104A0625X | 033564 | MO | Yes |
Addresses
Primary practice location
102 E Lillian Ave
Crane, MO 65633-9103
Mailing address
4781 S Twin Lakes Ave
Springfield, MO 65810-1548
Phone (417) 723-5900
Other names
- Crane Residential Care Home
Other providers in Crane, MO
- Ernesto T Padre
- Rolling Hills Home Care LLC
- School District R 3 Crane
- Paula Ann Sherwood
- Simply Well Counseling, LLC
- Damon J Thomas
- Pearlie Ursais
- Hannah Emile Wagner
- White Oak Medical, Inc
- White Oak Medical, Inc
All providers in Crane, MO · Assisted Living Facility (Mental Illness) in Missouri
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 22, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.