Provider Demographics
NPI:1427260363
Name:TOLIVER ADULT GATHERING SERVICE
Entity type:Organization
Organization Name:TOLIVER ADULT GATHERING SERVICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:CHARLOTTE
Authorized Official - Middle Name:A
Authorized Official - Last Name:TOLIVER
Authorized Official - Suffix:
Authorized Official - Credentials:ACTIVITY THERAPIST
Authorized Official - Phone:281-438-8772
Mailing Address - Street 1:16710 QUAIL VIEW CT
Mailing Address - Street 2:
Mailing Address - City:MISSOURI CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77489-5707
Mailing Address - Country:US
Mailing Address - Phone:281-416-0479
Mailing Address - Fax:
Practice Address - Street 1:16710 QUAIL VIEW CT
Practice Address - Street 2:
Practice Address - City:MISSOURI CITY
Practice Address - State:TX
Practice Address - Zip Code:77489-5707
Practice Address - Country:US
Practice Address - Phone:281-416-0479
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX171W00000171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171W00000XOther Service ProvidersContractorGroup - Multi-Specialty