Provider Demographics
NPI:1871206359
Name:TATE, CORDALE
Entity type:Individual
Prefix:
First Name:CORDALE
Middle Name:
Last Name:TATE
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 1:8417 GRAND DIVISION AVE
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44125-1321
Mailing Address - Country:US
Mailing Address - Phone:216-507-7564
Mailing Address - Fax:
Practice Address - Street 1:8417 GRAND DIVISION AVE
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44125-1321
Practice Address - Country:US
Practice Address - Phone:216-507-7564
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-29
Last Update Date:2023-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372500000XNursing Service Related ProvidersChore Provider