Basic Information
| Provider Information | |||||||||
| NPI: | 1245214477 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | TIDALHEALTH NANTICOKE, INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 801 MIDDLEFORD RD | ||||||||
| Address2: | |||||||||
| City: | SEAFORD | ||||||||
| State: | DE | ||||||||
| PostalCode: | 199733636 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3026296611 | ||||||||
| FaxNumber: | 3026286363 | ||||||||
| Practice Location | |||||||||
| Address1: | 801 MIDDLEFORD RD | ||||||||
| Address2: | |||||||||
| City: | SEAFORD | ||||||||
| State: | DE | ||||||||
| PostalCode: | 199733636 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3026296611 | ||||||||
| FaxNumber: | 3026286363 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/01/2005 | ||||||||
| LastUpdateDate: | 12/09/2020 | ||||||||
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| AuthorizedOfficialLastName: | MORRIS | ||||||||
| AuthorizedOfficialFirstName: | LINDA | ||||||||
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| AuthorizedOfficialTitleorPosition: | MANAGER - BUSINESS OFFICE | ||||||||
| AuthorizedOfficialTelephone: | 3025365021 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 12/09/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 282N00000X | HSPTL008 | DE | Y | Hospitals | General Acute Care Hospital |
ID Information
| ID | Type | State | Issuer | Description | 000067105 | 05 | DE | MEDICAID | 000067506 | 05 | DE | MEDICAID |