Provider Demographics
NPI:1407125735
Name:DALE MCNITT
Entity Type:Organization
Organization Name:DALE MCNITT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-248-4899
Mailing Address - Street 1:4612 N 56TH ST
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33610-7123
Mailing Address - Country:US
Mailing Address - Phone:813-763-0659
Mailing Address - Fax:813-367-2312
Practice Address - Street 1:3107 N 50TH ST
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33619-2302
Practice Address - Country:US
Practice Address - Phone:813-763-0659
Practice Address - Fax:813-367-2312
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:AGENCY FOR COMMUNITY TREATMENT SERVICES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-12-15
Last Update Date:2011-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW4182251V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251V00000XAgenciesVoluntary or Charitable