Provider Demographics
NPI:1396996534
Name:TOTALHEALTH LLC
Entity type:Organization
Organization Name:TOTALHEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:OKOSUN
Authorized Official - Middle Name:
Authorized Official - Last Name:EDORO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:401-244-5225
Mailing Address - Street 1:75 NEWMAN AVE
Mailing Address - Street 2:
Mailing Address - City:RUMFORD
Mailing Address - State:RI
Mailing Address - Zip Code:02916-1945
Mailing Address - Country:US
Mailing Address - Phone:401-453-0666
Mailing Address - Fax:
Practice Address - Street 1:300 TOLL GATE RD STE LL1
Practice Address - Street 2:
Practice Address - City:WARWICK
Practice Address - State:RI
Practice Address - Zip Code:02886-4448
Practice Address - Country:US
Practice Address - Phone:401-244-5225
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-07
Last Update Date:2008-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIMD11918207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty