Provider Demographics
NPI:1417317926
Name:THE TATE CENTER INC
Entity Type:Organization
Organization Name:THE TATE CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:IVAN
Authorized Official - Middle Name:TORRENCE
Authorized Official - Last Name:TATE
Authorized Official - Suffix:SR
Authorized Official - Credentials:MHSA
Authorized Official - Phone:863-697-1220
Mailing Address - Street 1:PO BOX 1582
Mailing Address - Street 2:
Mailing Address - City:FORT PIERCE
Mailing Address - State:FL
Mailing Address - Zip Code:34954-1582
Mailing Address - Country:US
Mailing Address - Phone:772-807-1500
Mailing Address - Fax:772-777-2889
Practice Address - Street 1:7986 100TH AVE
Practice Address - Street 2:
Practice Address - City:VERO BEACH
Practice Address - State:FL
Practice Address - Zip Code:32967-2754
Practice Address - Country:US
Practice Address - Phone:772-807-1500
Practice Address - Fax:772-777-2889
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-25
Last Update Date:2016-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL000975100251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health