Provider Demographics
NPI:1538909353
Name:TIDES HOSPICE LLC
Entity type:Organization
Organization Name:TIDES HOSPICE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ALEXANDRIA
Authorized Official - Middle Name:LOUISE
Authorized Official - Last Name:MACINNES
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:774-269-3018
Mailing Address - Street 1:320 WASHINGTON ST STE 3
Mailing Address - Street 2:
Mailing Address - City:NORWELL
Mailing Address - State:MA
Mailing Address - Zip Code:02061-1700
Mailing Address - Country:US
Mailing Address - Phone:781-295-0680
Mailing Address - Fax:781-486-3073
Practice Address - Street 1:320 WASHINGTON ST STE 3
Practice Address - Street 2:
Practice Address - City:NORWELL
Practice Address - State:MA
Practice Address - Zip Code:02061-1700
Practice Address - Country:US
Practice Address - Phone:781-295-0680
Practice Address - Fax:781-486-3073
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-29
Last Update Date:2024-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based