Provider Demographics
NPI:1194370601
Name:TATES HEALTH CARE, LLC
Entity Type:Organization
Organization Name:TATES HEALTH CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER
Authorized Official - Prefix:DR
Authorized Official - First Name:ARNETTE
Authorized Official - Middle Name:OLIVIA
Authorized Official - Last Name:TATES
Authorized Official - Suffix:
Authorized Official - Credentials:DNP, MSN, CRNP
Authorized Official - Phone:410-301-2081
Mailing Address - Street 1:7303 BEECH AVE
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21206
Mailing Address - Country:US
Mailing Address - Phone:410-301-2081
Mailing Address - Fax:
Practice Address - Street 1:7303 BEECH AVE
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21206
Practice Address - Country:US
Practice Address - Phone:410-301-2081
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-02
Last Update Date:2019-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7004796Medicaid