Provider Demographics
NPI:1043602394
Name:TIDEWATER HOME CARE, INC.
Entity type:Organization
Organization Name:TIDEWATER HOME CARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HR DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:GLORIA
Authorized Official - Middle Name:
Authorized Official - Last Name:WHEELER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:757-275-7010
Mailing Address - Street 1:1576 ASPIN ST STE C
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23502-1677
Mailing Address - Country:US
Mailing Address - Phone:757-275-7010
Mailing Address - Fax:757-275-7011
Practice Address - Street 1:1576 ASPIN ST STE C
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23502-1677
Practice Address - Country:US
Practice Address - Phone:757-275-7010
Practice Address - Fax:757-275-7011
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-24
Last Update Date:2015-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA913778251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health