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General NPI Number Information
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NPI Number | 1417317926
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Entity Type | Organization
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Legal Business Name | THE TATE CENTER INC
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Dates
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Enumeration Date | 02/25/2016
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Last Update Date | 02/25/2016
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Provider Practice Location Address
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Address Line | 7986 100TH AVE
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City | VERO BEACH
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State | FL
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Zip | 32967-2754
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Country | US
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Telephone | 772-807-1500
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Fax | 772-777-2889
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Provider Business Mailing Address
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Address Line | PO BOX 1582
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City | FORT PIERCE
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State | FL
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Zip | 34954-1582
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Country | US
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Telephone | 772-807-1500
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Fax | 772-777-2889
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MR. IVAN TORRENCE TATE SR.
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Credential | MHSA
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Telephone | 863-697-1220
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 000975100
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License Number State | FL
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