Healthcare Provider Details

I. General information

NPI: 1518884113
Provider Name (Legal Business Name): REGINA DENISE TATE RESIDENTIAL CARE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/02/2026
Last Update Date: 07/03/2026
Certification Date: 07/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

917 ONSLOW DR
GREENSBORO NC
27408-7709
US

IV. Provider business mailing address

3012 ROYALTON DR
GREENSBORO NC
27406-6226
US

V. Phone/Fax

Practice location:
  • Phone: 336-549-8815
  • Fax:
Mailing address:
  • Phone: 336-549-8815
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3104A0625X
TaxonomyAssisted Living Facility (Mental Illness)
License Number
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: