Provider Demographics
NPI:1902096712
Name:CHANGING TIDES LLC
Entity Type:Organization
Organization Name:CHANGING TIDES LLC
Other - Org Name:CLAIRE BROWN LMP
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:LMP MANAGER
Authorized Official - Prefix:MISS
Authorized Official - First Name:CLAIRE
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:LICENSED MASSAGE PRA
Authorized Official - Phone:360-731-9717
Mailing Address - Street 1:13250 PHELPS ROAD NE
Mailing Address - Street 2:
Mailing Address - City:BAINBRIDGE ISLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98110-4141
Mailing Address - Country:US
Mailing Address - Phone:360-731-9717
Mailing Address - Fax:
Practice Address - Street 1:21222 VIKING AVE NW
Practice Address - Street 2:
Practice Address - City:POULSBO
Practice Address - State:WA
Practice Address - Zip Code:98370
Practice Address - Country:US
Practice Address - Phone:360-731-9717
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-27
Last Update Date:2007-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00002068225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty