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General NPI Number Information
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NPI Number | 1972274546
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Entity Type | Organization
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Legal Business Name | TIDEWELL HOSPICE, INC.
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Dates
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Enumeration Date | 09/23/2021
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Last Update Date | 07/02/2025
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Provider Practice Location Address
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Address Line | 5955 RAND BLVD
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City | SARASOTA
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State | FL
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Zip | 34238-5160
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Country | US
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Telephone | 941-552-7500
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Fax |
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Provider Business Mailing Address
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Address Line | 5955 RAND BLVD
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City | SARASOTA
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State | FL
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Zip | 34238-5160
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Country | US
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Telephone | 941-552-7500
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Fax |
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Authorized Official
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Title or Position | CFO
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Name | SAIDA BOUHAMID
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Credential |
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Telephone | 941-552-7599
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2080H0002X
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Taxonomy Name | Pediatric Hospice and Palliative Medicine Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 251G00000X
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Taxonomy Name | Community Based Hospice Care Agency
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License Number |
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License Number State |
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