Provider Demographics
NPI:1417954645
Name:TIDEWELL HOSPICE, INC.
Entity Type:Organization
Organization Name:TIDEWELL HOSPICE, INC.
Other - Org Name:EMPATH TIDEWELL HOSPICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:SAIDA
Authorized Official - Middle Name:
Authorized Official - Last Name:BOUHAMID
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:941-552-7500
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:941-552-7500
Mailing Address - Fax:941-926-1613
Practice Address - Street 1:5955 RAND BLVD
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34238-5160
Practice Address - Country:US
Practice Address - Phone:941-552-7500
Practice Address - Fax:941-552-7520
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-01
Last Update Date:2023-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL5028096251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL087527908Medicaid
FLU12OtherBCBS
FL087527900Medicaid
FLU12OtherBCBS
FL101521Medicare ID - Type UnspecifiedPROVIDER ID