1992914113 NPI number — MENTAL HEALTH CARE INC DBA GRACEPOINT

Table of content: (NPI 1992914113)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1992914113 NPI number — MENTAL HEALTH CARE INC DBA GRACEPOINT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MENTAL HEALTH CARE INC DBA GRACEPOINT
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:
GRAHAM AT GRACEPOINT
Provider Other Organization Name Type Code:
5
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:
1992914113
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/14/2016
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:
2400 E HENRY AVE
Provider Second Line Business Practice Location Address:
GRAHAM AT GRACEPOINT
Provider Business Practice Location Address City Name:
TAMPA
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33610-4435
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
813-272-2878
Provider Business Practice Location Address Fax Number:
813-231-7324
Provider Enumeration Date:
05/22/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
RUTHERFORD
Authorized Official First Name:
JOSEPH
Authorized Official Middle Name:
F.
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
813-239-8069

Provider Taxonomy Codes

  • Taxonomy code: 261QM0801X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 261QM0801X , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 140365600 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".