Provider Demographics
NPI:1619590841
Name:TATE HEALTHCARE SERIVES
Entity Type:Organization
Organization Name:TATE HEALTHCARE SERIVES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SAMUEL
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-407-9110
Mailing Address - Street 1:1129 DOVE RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:BAHAMA
Mailing Address - State:NC
Mailing Address - Zip Code:27503-9739
Mailing Address - Country:US
Mailing Address - Phone:919-407-9110
Mailing Address - Fax:
Practice Address - Street 1:9711 DAVID TAYLOR DR APT 139
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28262-2370
Practice Address - Country:US
Practice Address - Phone:919-407-9110
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-05-21
Last Update Date:2020-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care