Healthcare Provider Details

I. General information

NPI: 1295891661
Provider Name (Legal Business Name): TIDES FAMILY SERVICES, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/29/2006
Last Update Date: 06/16/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

215 WASHINGTON ST
WEST WARWICK RI
02893-5017
US

IV. Provider business mailing address

215 WASHINGTON ST
WEST WARWICK RI
02893-5017
US

V. Phone/Fax

Practice location:
  • Phone: 401-822-1360
  • Fax:
Mailing address:
  • Phone: 401-822-1360
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MS. BETH ANN BIXBY
Title or Position: COO
Credential: LICSW
Phone: 401-822-1360