1134240971 NPI number — CHANGING TIDES HOME HEALTH, INC.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1134240971 NPI number — CHANGING TIDES HOME HEALTH, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CHANGING TIDES HOME HEALTH, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1134240971
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/21/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

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

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3067 TAMIAMI TRL
Provider Second Line Business Practice Location Address:
UNIT 4
Provider Business Practice Location Address City Name:
PORT CHARLOTTE
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33952-6601
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
239-461-9009
Provider Business Practice Location Address Fax Number:
239-461-9008
Provider Enumeration Date:
04/02/2007

Additional Information

Authorized Official

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

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X , with the licence number:  HHA299992570 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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