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General NPI Number Information
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NPI Number | 1871088922
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Entity Type | Organization
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Legal Business Name | TATE ENTERPRISES, LLC
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Dates
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Enumeration Date | 06/29/2018
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Last Update Date | 06/29/2018
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Provider Practice Location Address
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Address Line | 1105 LAURA AVE
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City | JACKSON
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State | MS
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Zip | 39209-7008
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Country | US
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Telephone | 601-940-8074
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Fax |
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Provider Business Mailing Address
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Address Line | 1021 MELOAN DR
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City | JACKSON
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State | MS
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Zip | 39209-7012
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Country | US
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Telephone | 601-940-8074
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | MS. ZENOTHA ROBINSON
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Credential |
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Telephone | 601-940-8074
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320900000X
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Taxonomy Name | Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
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License Number |
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License Number State | MS
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