Tidal Wave Recovery Center LLC

Primary specialty

Substance Use Disorder Rehabilitation Clinic/CenterTaxonomy code 261QR0405X

Legal business name

TIDAL WAVE RECOVERY CENTER LLC

Practice address

3396 Miller St
Philadelphia, PA 19134-5325

Phone

(215) 901-3512

NPI assigned

Mar 31, 2026

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mark Francis Werner

Title

Ceo

Phone

(215) 370-3646

Specialties & licenses 4

Addresses

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1774915200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1774915200000",
    "number": "1114867934",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3396 MILLER ST",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191345325",
            "telephone_number": "215-901-3512"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3396 MILLER ST",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191345325",
            "telephone_number": "215-901-3512"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TIDAL WAVE RECOVERY CENTER LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2026-03-31",
        "last_updated": "2026-03-31",
        "certification_date": "2026-03-31",
        "status": "A",
        "authorized_official_last_name": "WERNER",
        "authorized_official_first_name": "MARK",
        "authorized_official_middle_name": "FRANCIS",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "215-370-3646"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QM0850X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adult Mental Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QR0405X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation, Substance Use Disorder",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "324500000X",
            "taxonomy_group": "",
            "desc": "Substance Abuse Rehabilitation Facility",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Alanna Marie Ticali
• Corrie Ann Tice
• Julianne Tice, DPT
• Erin Ticehurst, PHARM.D.
• Anna Tichtchenko
• Jerica Tidwell
• Taliah S Tidwell, OT
• Michael William Tieff, D.O.
• Seniboye B. Tienabeso, D.M.D.
• Anna-Marie Tierney, M.D.

• Substance Use Disorder Rehabilitation Clinic/Center in Philadelphia, PA
• Providers in Philadelphia, PA by specialty
• Substance Use Disorder Rehabilitation Clinic/Center in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 31, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.