1619645785 NPI number — MENTAL HEALTH CARE, INC

Table of content: (NPI 1619645785)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1619645785 NPI number — MENTAL HEALTH CARE, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MENTAL HEALTH CARE, INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1619645785
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/06/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5707 N 22ND ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TAMPA
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33610-4350
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
813-239-8069
Provider Business Mailing Address Fax Number:
813-231-7324

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2212 E HENRY AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TAMPA
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33610-4433
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
813-239-8069
Provider Business Practice Location Address Fax Number:
813-231-7324
Provider Enumeration Date:
09/02/2021

Additional Information

Authorized Official

Authorized Official Last Name:
TYSON
Authorized Official First Name:
ROAYA
Authorized Official Middle Name:
F
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
813-239-8069

Provider Taxonomy Codes

  • Taxonomy code: 283Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 111436500 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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