Healthcare Provider Details

I. General information

NPI: 1285491951
Provider Name (Legal Business Name): TIDEWATER SUPERIOR HOME SUPPORT LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/29/2024
Last Update Date: 07/30/2025
Certification Date: 07/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 E MAIN ST # 1545
NORFOLK VA
23510-2205
US

IV. Provider business mailing address

500 E MAIN ST # 1600-7
NORFOLK VA
23510-2205
US

V. Phone/Fax

Practice location:
  • Phone: 757-802-7600
  • Fax:
Mailing address:
  • Phone: 757-802-7600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: MR. DERRICK SAUNDERS
Title or Position: CEO
Credential:
Phone: 757-802-7600