- Enrollment id
- O20051219000111
- Enrollment state
- FL
- Provider type code
- 00-08
- Provider type text
- PART A PROVIDER - HOSPICE
- Npi
- 1417954645
- Multiple npi flag
- N
- Ccn
- 101521
- Associate id
- 1456260868
- Organization name
- TIDEWELL HOSPICE, INC.
- Doing business as name
- EMPATH TIDEWELL HOSPICE
- Incorporation date
- 1987-08-05
- Incorporation state
- FL
- Organization type structure
- CORPORATION
- Proprietary nonprofit
- N
- Address line 1
- 5955 RAND BLVD
- City
- SARASOTA
- State
- FL
- Zip code
- 342385160