1356388409 NPI number — CHANGING TIDES HOME HEALTH, INC.

Table of content: (NPI 1356388409)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1356388409 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:
1356388409
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/19/2008
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:
727-786-7088

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
12381 S CLEVELAND AVE
Provider Second Line Business Practice Location Address:
SUITE 404
Provider Business Practice Location Address City Name:
FT MYERS
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33907-3893
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:
05/31/2006

Additional Information

Authorized Official

Authorized Official Last Name:
BRAGG
Authorized Official First Name:
DENISE
Authorized Official Middle Name:
Authorized Official Title or Position:
VICE PRESIDENT
Authorized Official Telephone Number:
954-834-2222

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X , with the licence number:  HHA299991873 , 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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