Provider Demographics
NPI:1134240971
Name:CHANGING TIDES HOME HEALTH, INC.
Entity type:Organization
Organization Name:CHANGING TIDES HOME HEALTH, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CONTROLLER
Authorized Official - Prefix:
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:
Authorized Official - Last Name:MEDLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:727-786-5520
Mailing Address - Street 1:33920 US HIGHWAY 19 N
Mailing Address - Street 2:SUITE 341
Mailing Address - City:PALM HARBOR
Mailing Address - State:FL
Mailing Address - Zip Code:34684-2654
Mailing Address - Country:US
Mailing Address - Phone:727-786-5520
Mailing Address - Fax:727-787-6893
Practice Address - Street 1:3067 TAMIAMI TRL
Practice Address - Street 2:UNIT 4
Practice Address - City:PORT CHARLOTTE
Practice Address - State:FL
Practice Address - Zip Code:33952-6601
Practice Address - Country:US
Practice Address - Phone:239-461-9009
Practice Address - Fax:239-461-9008
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-02
Last Update Date:2008-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLHHA299992570251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL108054Medicare ID - Type UnspecifiedPROVIDER NUMBER