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General NPI Number Information
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NPI Number | 1578894788
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Entity Type | Organization
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Legal Business Name | TIDEWELL HOME HEALTH SERVICES
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Dates
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Enumeration Date | 01/28/2010
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Last Update Date | 01/27/2023
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Provider Practice Location Address
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Address Line | 3355 26TH ST W
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City | BRADENTON
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State | FL
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Zip | 34205-3607
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Country | US
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Telephone | 941-782-4900
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Fax | 941-739-8937
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Provider Business Mailing Address
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Address Line | 3355 26TH ST W
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City | BRADENTON
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State | FL
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Zip | 34205-3607
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Country | US
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Telephone | 941-782-4900
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Fax | 941-739-8937
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Authorized Official
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Title or Position | PRESIDENT/CEO
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Name | MRS. MARGE MAISTO
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Credential | RN, MA, MS
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Telephone | 941-552-7500
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number |
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License Number State |
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