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General NPI Number Information
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NPI Number | 1538047089
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Entity Type | Organization
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Legal Business Name | TTOLBERT 1964 LLC
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Dates
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Enumeration Date | 08/23/2025
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Last Update Date | 08/23/2025
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Provider Practice Location Address
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Address Line | 200 N SAINT CLAIR ST APT 2308
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City | TOLEDO
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State | OH
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Zip | 43604-1555
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Country | US
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Telephone | 567-318-9604
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Fax | 567-318-9604
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Provider Business Mailing Address
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Address Line | 200 N SAINT CLAIR ST APT 2308
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City | TOLEDO
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State | OH
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Zip | 43604-1555
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Country | US
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Telephone | 567-318-9604
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Fax | 567-318-9604
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Authorized Official
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Title or Position | OWNER
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Name | TOMMY TERRELL JONES
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Credential |
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Telephone | 567-318-9604
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 385HR2060X
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Taxonomy Name | Child Intellectual and/or Developmental Disabilities Respite Care
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License Number |
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License Number State |
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