Provider Demographics
NPI:1932781796
Name:THE MCCRAE HOUSE INC
Entity Type:Organization
Organization Name:THE MCCRAE HOUSE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PERTRICE
Authorized Official - Middle Name:
Authorized Official - Last Name:PERRY
Authorized Official - Suffix:
Authorized Official - Credentials:BA
Authorized Official - Phone:813-567-6168
Mailing Address - Street 1:2624 E 29TH AVE
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33605-1425
Mailing Address - Country:US
Mailing Address - Phone:813-567-6168
Mailing Address - Fax:
Practice Address - Street 1:2624 E 29TH AVE
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33605-1425
Practice Address - Country:US
Practice Address - Phone:813-567-6168
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:THE MCCRAE HOUSE INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-04-22
Last Update Date:2021-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty