Provider Demographics
NPI:1992914113
Name:MENTAL HEALTH CARE INC DBA GRACEPOINT
Entity type:Organization
Organization Name:MENTAL HEALTH CARE INC DBA GRACEPOINT
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:F
Authorized Official - Last Name:RUTHERFORD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-239-8069
Mailing Address - Street 1:5707 N 22ND ST
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33610-4350
Mailing Address - Country:US
Mailing Address - Phone:813-239-8069
Mailing Address - Fax:813-231-7324
Practice Address - Street 1:2400 E HENRY AVE
Practice Address - Street 2:GRAHAM AT GRACEPOINT
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33610-4435
Practice Address - Country:US
Practice Address - Phone:813-272-2878
Practice Address - Fax:813-231-7324
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MENTAL HEALTH CARE, INC DBA GRACEPOINT
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-05-22
Last Update Date:2016-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QM0801X
FL261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL140365600Medicaid
FL00544Medicare UPIN