Provider Demographics
NPI:1376815746
Name:HOSPICE AND PALLIATIVE CARE OF TIDEWATER
Entity Type:Organization
Organization Name:HOSPICE AND PALLIATIVE CARE OF TIDEWATER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:ABRAHAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:757-420-2512
Mailing Address - Street 1:5000 CORPORATE WOODS DR STE 500
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23462-4429
Mailing Address - Country:US
Mailing Address - Phone:757-321-2242
Mailing Address - Fax:757-321-2236
Practice Address - Street 1:5000 CORPORATE WOODS DR STE 500
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23462-4429
Practice Address - Country:US
Practice Address - Phone:757-321-2242
Practice Address - Fax:757-321-2236
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-01
Last Update Date:2021-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based