Provider Demographics
NPI:1891406393
Name:TIDES OF LIFE HOME CARE, LLC
Entity Type:Organization
Organization Name:TIDES OF LIFE HOME CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JEAN
Authorized Official - Middle Name:
Authorized Official - Last Name:CRAIG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:803-399-0639
Mailing Address - Street 1:114 HAYGOOD AVE STE A
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:SC
Mailing Address - Zip Code:29072-2673
Mailing Address - Country:US
Mailing Address - Phone:803-399-0639
Mailing Address - Fax:
Practice Address - Street 1:114 HAYGOOD AVE STE A
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:SC
Practice Address - Zip Code:29072-2673
Practice Address - Country:US
Practice Address - Phone:803-399-0639
Practice Address - Fax:803-399-0575
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-12-06
Last Update Date:2022-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care