=====================================================
General NPI Number Information
=====================================================
NPI Number | 1164389326
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | TIDES FAMILY SERVICES
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/08/2026
-----------------------------------------------------
Last Update Date | 01/08/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 215 WASHINGTON ST
-----------------------------------------------------
City | WEST WARWICK
-----------------------------------------------------
State | RI
-----------------------------------------------------
Zip | 02893-5176
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 401-822-1360
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 215 WASHINGTON ST
-----------------------------------------------------
City | WEST WARWICK
-----------------------------------------------------
State | RI
-----------------------------------------------------
Zip | 02893-5176
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 401-822-1360
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | EXECUTIVE ASSISTANT TO THE CEO
-----------------------------------------------------
Name | KATELYN ARCHETTO
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 401-871-0659
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 172V00000X
-----------------------------------------------------
Taxonomy Name | Community Health Worker
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------