Provider Demographics
NPI:1154483642
Name:TIDEWELL HOSPICE & PALLIATIVE CARE
Entity Type:Organization
Organization Name:TIDEWELL HOSPICE & PALLIATIVE CARE
Other - Org Name:JOURNEYS HOMECARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:FLEECE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:941-552-7525
Mailing Address - Street 1:5955 RAND BLVD
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34238-5160
Mailing Address - Country:US
Mailing Address - Phone:941-552-7683
Mailing Address - Fax:941-552-7520
Practice Address - Street 1:2967 BEE RIDGE RD
Practice Address - Street 2:SUITE 3
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34239-7113
Practice Address - Country:US
Practice Address - Phone:941-929-2369
Practice Address - Fax:941-929-2363
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-14
Last Update Date:2023-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL299991723251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLJT8OtherBCBS PROVIDER NUMBER
FL650990800Medicaid