Provider Demographics
NPI:1891489654
Name:ROLLING TIDES RECOVERY LLC
Entity Type:Organization
Organization Name:ROLLING TIDES RECOVERY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RACHEL
Authorized Official - Middle Name:
Authorized Official - Last Name:HARDWICK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:727-328-4567
Mailing Address - Street 1:620 N FLORIDA AVE
Mailing Address - Street 2:
Mailing Address - City:TARPON SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:34689-2109
Mailing Address - Country:US
Mailing Address - Phone:727-328-4567
Mailing Address - Fax:
Practice Address - Street 1:620 N FLORIDA AVE
Practice Address - Street 2:
Practice Address - City:TARPON SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:34689-2109
Practice Address - Country:US
Practice Address - Phone:727-328-4567
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-05
Last Update Date:2024-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary CareGroup - Multi-Specialty
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care