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General NPI Number Information
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NPI Number | 1669920005
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Entity Type | Organization
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Legal Business Name | TIDEWATER HOSPICE AUGUSTA LLC
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Dates
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Enumeration Date | 09/14/2016
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Last Update Date | 09/14/2016
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Provider Practice Location Address
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Address Line | 206 PITCARIN WAY SUITE B
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City | AUGUSTA
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State | GA
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Zip | 30909-5766
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Country | US
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Telephone | 803-600-0842
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Fax |
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Provider Business Mailing Address
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Address Line | 335 PLEASANT POINT DRIVE
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City | BEAUFORT
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State | SC
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Zip | 29907
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Country | US
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Telephone | 803-600-0842
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Fax |
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Authorized Official
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Title or Position | CFO
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Name | STEPHANIE GUEST
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Credential | RPH
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Telephone | 803-600-0842
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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 | 1210432H
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License Number State | GA
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