Provider Demographics
NPI:1679172167
Name:TSP HOLDINGS LLC
Entity type:Organization
Organization Name:TSP HOLDINGS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TEHJAN
Authorized Official - Middle Name:
Authorized Official - Last Name:PRENDIVILLE
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:239-848-6515
Mailing Address - Street 1:2703 N CRISWELL AVE
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85745-1146
Mailing Address - Country:US
Mailing Address - Phone:239-848-6515
Mailing Address - Fax:
Practice Address - Street 1:3040 N CAMPBELL AVE STE 110
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85719-7317
Practice Address - Country:US
Practice Address - Phone:520-298-9281
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-26
Last Update Date:2020-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care