Provider Demographics
NPI:1346224011
Name:MENTAL HEALTH CARE, INC
Entity Type:Organization
Organization Name:MENTAL HEALTH CARE, INC
Other - Org Name:GRACEPOINT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO EFFECTIVE 9/1/2022
Authorized Official - Prefix:
Authorized Official - First Name:ROAYA
Authorized Official - Middle Name:
Authorized Official - Last Name:TYSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-239-8069
Mailing Address - Street 1:5707 N. 22ND STREET
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33610-4350
Mailing Address - Country:US
Mailing Address - Phone:813-239-8069
Mailing Address - Fax:813-231-7324
Practice Address - Street 1:5707 N. 22ND STREET
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33610-4350
Practice Address - Country:US
Practice Address - Phone:813-239-8069
Practice Address - Fax:813-231-7324
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MENTAL HEALTH CARE, INC GRACEPOI
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-12-06
Last Update Date:2024-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No251B00000XAgenciesCase Management
No251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL227811Medicaid
FL060272800Medicaid
FL060272801Medicaid
FL0827999Medicaid
FL21336Medicaid
FL060272815Medicaid
FL060272815Medicaid