Provider Demographics
NPI:1730318171
Name:TORSHA TIBBETTS
Entity Type:Organization
Organization Name:TORSHA TIBBETTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TORSHA
Authorized Official - Middle Name:
Authorized Official - Last Name:TIBBETTS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:207-341-4066
Mailing Address - Street 1:442 TROY RD
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:ME
Mailing Address - Zip Code:04929-3024
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:442 TROY RD
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:ME
Practice Address - Zip Code:04929-3024
Practice Address - Country:US
Practice Address - Phone:207-341-4066
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-07
Last Update Date:2009-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care