Provider Demographics
NPI:1619676137
Name:PATE, DANTREEL
Entity Type:Individual
Prefix:
First Name:DANTREEL
Middle Name:
Last Name:PATE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 N CENTRAL AVE FL 18TH AND 19TH FLOOR PHOENIX ARIZONA
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85004-2322
Mailing Address - Country:US
Mailing Address - Phone:480-799-7927
Mailing Address - Fax:
Practice Address - Street 1:2 N CENTRAL AVE FL 1819
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85004-2322
Practice Address - Country:US
Practice Address - Phone:480-799-7927
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-23
Last Update Date:2023-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320700000XResidential Treatment FacilitiesResidential Treatment Facility, Physical Disabilities