1952285645 NPI number — TIDES OF CHANGE BEHAVIORAL HEALTH SERVICES, LLC

Table of content: ALFONSO DAMARUS ARMWOOD RN (NPI 1316754674)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1952285645 NPI number — TIDES OF CHANGE BEHAVIORAL HEALTH SERVICES, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TIDES OF CHANGE BEHAVIORAL HEALTH SERVICES, LLC
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:
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:
1952285645
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/05/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3703 SKIPTON CIR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
YORK
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
17402-4420
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
717-873-6207
Provider Business Mailing Address Fax Number:
717-467-4077

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1600 6TH AVE STE 103
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
YORK
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17403-2626
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
717-973-6786
Provider Business Practice Location Address Fax Number:
717-483-2088
Provider Enumeration Date:
08/05/2025

Additional Information

Authorized Official

Authorized Official Last Name:
HEIST
Authorized Official First Name:
DANIELLE
Authorized Official Middle Name:
Authorized Official Title or Position:
PROFESSIONAL COUNSELOR
Authorized Official Telephone Number:
717-873-6207

Provider Taxonomy Codes

  • Taxonomy code: 101YP2500X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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