Provider Demographics
NPI:1235259631
Name:OCEAN TIDES
Entity Type:Organization
Organization Name:OCEAN TIDES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT CEO
Authorized Official - Prefix:
Authorized Official - First Name:BRENDAN
Authorized Official - Middle Name:J
Authorized Official - Last Name:GERRITY
Authorized Official - Suffix:
Authorized Official - Credentials:MA CAGS
Authorized Official - Phone:401-789-1016
Mailing Address - Street 1:635 OCEAN ROAD
Mailing Address - Street 2:
Mailing Address - City:NARRAGANSETT
Mailing Address - State:RI
Mailing Address - Zip Code:02882
Mailing Address - Country:US
Mailing Address - Phone:401-789-1016
Mailing Address - Fax:401-788-0924
Practice Address - Street 1:635 OCEAN RD
Practice Address - Street 2:
Practice Address - City:NARRAGANSETT
Practice Address - State:RI
Practice Address - Zip Code:02882-1314
Practice Address - Country:US
Practice Address - Phone:401-789-1016
Practice Address - Fax:401-788-0924
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RI41599322D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children