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General NPI Number Information
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NPI Number | 1972417459
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Entity Type | Organization
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Legal Business Name | TITO INC
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Dates
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Enumeration Date | 09/30/2026
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Last Update Date | 09/30/2026
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Provider Practice Location Address
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Address Line | 130 N HAMILTON ST STE 101
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City | GEORGETOWN
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State | KY
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Zip | 40324-1791
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Country | US
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Telephone | 502-557-2752
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Fax |
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Provider Business Mailing Address
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Address Line | 130 N HAMILTON ST STE 101
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City | GEORGETOWN
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State | KY
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Zip | 40324-1791
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Country | US
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Telephone | 502-557-2752
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Fax |
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Authorized Official
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Title or Position | FOUNDER
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Name | ERICA DAVENPORT
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Credential | PEER SUPPORT SPECIAL
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Telephone | 502-557-2752
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0405X
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Taxonomy Name | Substance Use Disorder Rehabilitation Clinic/Center
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License Number |
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License Number State | NULL
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