Provider Demographics
NPI:1235585761
Name:TIDEWATER PCA TRAINING
Entity Type:Organization
Organization Name:TIDEWATER PCA TRAINING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:NICHOLETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:CADORE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:757-675-7270
Mailing Address - Street 1:4605 PEMBROKE LAKE CIR
Mailing Address - Street 2:SUITE 303
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23455-6434
Mailing Address - Country:US
Mailing Address - Phone:757-675-7270
Mailing Address - Fax:
Practice Address - Street 1:4605 PEMBROKE LAKE CIR
Practice Address - Street 2:SUITE 303
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23455-6434
Practice Address - Country:US
Practice Address - Phone:757-675-7270
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-13
Last Update Date:2016-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health