Provider Demographics
NPI:1679390405
Name:XDHEALTH LLC
Entity type:Organization
Organization Name:XDHEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DERRICK
Authorized Official - Middle Name:
Authorized Official - Last Name:KRETSCHMER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:253-398-4765
Mailing Address - Street 1:3502 S MASON AVE APT 7E
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98409-8535
Mailing Address - Country:US
Mailing Address - Phone:661-220-4947
Mailing Address - Fax:
Practice Address - Street 1:2367 TACOMA AVE S # 102
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98402-1409
Practice Address - Country:US
Practice Address - Phone:509-289-2980
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-23
Last Update Date:2024-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)