Provider Demographics
NPI:1316188733
Name:TIDEWATER HEALTHCARE SERVICES, INC
Entity Type:Organization
Organization Name:TIDEWATER HEALTHCARE SERVICES, INC
Other - Org Name:BRIGHTSTAR HEALTHCARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:WALTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:757-227-4047
Mailing Address - Street 1:1214 PROGRESSIVE DR
Mailing Address - Street 2:SUITE 102
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23320-2848
Mailing Address - Country:US
Mailing Address - Phone:757-227-4047
Mailing Address - Fax:757-227-4109
Practice Address - Street 1:1214 PROGRESSIVE DR
Practice Address - Street 2:SUITE 102
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23320-2848
Practice Address - Country:US
Practice Address - Phone:757-227-4047
Practice Address - Fax:757-227-4109
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-14
Last Update Date:2016-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No251F00000XAgenciesHome Infusion