Healthcare Provider Details

I. General information

NPI: 1487687273
Provider Name (Legal Business Name): COVE BEHAVIORAL HEALTH, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/08/2006
Last Update Date: 10/05/2021
Certification Date: 10/05/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4422 E COLUMBUS DRIVE
TAMPA FL
33605
US

IV. Provider business mailing address

4422 E COLUMBUS DRIVE
TAMPA FL
33605
US

V. Phone/Fax

Practice location:
  • Phone: 813-384-4216
  • Fax: 813-623-3730
Mailing address:
  • Phone: 813-384-4216
  • Fax: 813-623-3730

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251V00000X
TaxonomyVoluntary or Charitable Agency
License Number858012643687
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code251V00000X
TaxonomyVoluntary or Charitable Agency
License Number858012643687C2
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MRS. DEANNA OBREGON
Title or Position: CEO
Credential:
Phone: 813-384-4161