Provider Demographics
NPI:1285906081
Name:TAKO, INC
Entity type:Organization
Organization Name:TAKO, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:AMIE
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:HADDIX
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:304-637-8181
Mailing Address - Street 1:320 RANDOLPH AVE
Mailing Address - Street 2:
Mailing Address - City:ELKINS
Mailing Address - State:WV
Mailing Address - Zip Code:26241-3941
Mailing Address - Country:US
Mailing Address - Phone:304-591-4519
Mailing Address - Fax:304-591-4549
Practice Address - Street 1:320 RANDOLPH AVE
Practice Address - Street 2:
Practice Address - City:ELKINS
Practice Address - State:WV
Practice Address - Zip Code:26241-3941
Practice Address - Country:US
Practice Address - Phone:304-591-4519
Practice Address - Fax:304-591-4549
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-08
Last Update Date:2012-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care