Organization
TIDEWATER HOMESPEC, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. CLARENCE O LONGMORE III (MANAGING PARTNER)
(757) 409-1969
Entity
Organization
Contact information
Practice address
1024 PATRICK HENRY WAY, VIRGINIA BEACH, VA 23455-4826
(757) 409-1969
Mailing address
1024 PATRICK HENRY WAY, VIRGINIA BEACH, VA 23455-4826
(757) 409-1969
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
2705096060
VA
Other
Enumeration date
10/13/2008
Last updated
10/13/2008
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