MEDICARE: CHANGING TIDES HOME HEALTH, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251E00000X	Home Health Agency	HHA299992570	FL

General Provider Information

NPI Number	:	1134240971
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHANGING TIDES HOME HEALTH, INC.

Provider Business Mailing Address
First Line	:	33920 US HIGHWAY 19 N
Second Line	:	SUITE 341
City	:	PALM HARBOR
State	:	FL
Zip	:	34684-2654
Country	:	US
Telephone Number	:	727-786-5520
Fax Number	:	727-787-6893

Provider Business Practice Location Address
First Line	:	3067 TAMIAMI TRL
Second Line	:	UNIT 4
City	:	PORT CHARLOTTE
State	:	FL
Zip	:	33952-6601
Country	:	US
Telephone Number	:	239-461-9009
Fax Number	:	239-461-9008

Authorized Official
Title or Position	:	CONTROLLER
Name	:	DEBORAH MEDLEY
Credential	:
Telephone Number	:	727-786-5520

Provider Enumeration Date	:	04/02/2007
Last Update Date	:	07/21/2008

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