Healthcare Provider Details

I. General information

NPI: 1245214477
Provider Name (Legal Business Name): TIDALHEALTH NANTICOKE, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/01/2005
Last Update Date: 11/21/2024
Certification Date: 11/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 MIDDLEFORD RD
SEAFORD DE
19973-3636
US

IV. Provider business mailing address

801 MIDDLEFORD RD
SEAFORD DE
19973-3636
US

V. Phone/Fax

Practice location:
  • Phone: 302-629-6611
  • Fax: 302-628-6363
Mailing address:
  • Phone: 302-629-6611
  • Fax: 302-628-6363

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QR0200X
TaxonomyRadiology Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License NumberHSPTL008
License Number StateDE
# 4
Primary TaxonomyN
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number State

VIII. Authorized Official

Name: STEPHANIE GARY
Title or Position: VICE PRESIDENT-FINANCE/ CFO
Credential:
Phone: 410-912-6059