MEDICARE: HOSPICE AND PALLIATIVE CARE OF TIDEWATER

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	251G00000X	Community Based Hospice Care Agency

General Provider Information

NPI Number	:	1376815746
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HOSPICE AND PALLIATIVE CARE OF TIDEWATER

Provider Business Mailing Address
First Line	:	5000 CORPORATE WOODS DR STE 500
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23462-4429
Country	:	US
Telephone Number	:	757-321-2242
Fax Number	:	757-321-2236

Provider Business Practice Location Address
First Line	:	5000 CORPORATE WOODS DR STE 500
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23462-4429
Country	:	US
Telephone Number	:	757-321-2242
Fax Number	:	757-321-2236

Authorized Official
Title or Position	:	CEO
Name	:	MR. DAVID ABRAHAM
Credential	:
Telephone Number	:	757-420-2512

Provider Enumeration Date	:	02/01/2012
Last Update Date	:	06/15/2021

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