Provider Demographics
NPI:1245823160
Name:TIDES WELLNESS CENTER LLC
Entity type:Organization
Organization Name:TIDES WELLNESS CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:CAROLYN
Authorized Official - Middle Name:
Authorized Official - Last Name:ARTALE
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:973-464-6985
Mailing Address - Street 1:617 UNION AVE STE 10
Mailing Address - Street 2:
Mailing Address - City:BRIELLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08730-1838
Mailing Address - Country:US
Mailing Address - Phone:973-464-6985
Mailing Address - Fax:
Practice Address - Street 1:617 UNION AVE STE 10
Practice Address - Street 2:
Practice Address - City:BRIELLE
Practice Address - State:NJ
Practice Address - Zip Code:08730-1838
Practice Address - Country:US
Practice Address - Phone:973-464-6985
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-12
Last Update Date:2021-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)