# TIDEWATER HOME HEALTH, PA

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1245659127
- **Authorized official:** STEPHANIE GUEST (CFO)
- **Authorized official phone:** (803) 600-0842

## Contact information

- **Practice address:** 215 MEDICAL CIR, WEST COLUMBIA, SC 29169-3653
- **Practice address phone:** (803) 753-7017
- **Practice address fax:** (803) 739-7079
- **Mailing address:** 215 MEDICAL CIR, WEST COLUMBIA, SC 29169-3653
- **Mailing address phone:** (803) 753-7017
- **Mailing address fax:** (803) 739-7079

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 251E00000X | Home Health Agency | 460342 | SC | Yes |

## Other

- **Enumeration date:** 04/08/2014
- **Last updated:** 04/08/2014