Provider Demographics
NPI:1538047089
Name:TTOLBERT 1964 LLC
Entity type:Organization
Organization Name:TTOLBERT 1964 LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TOMMY
Authorized Official - Middle Name:TERRELL
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:567-318-9604
Mailing Address - Street 1:200 N SAINT CLAIR ST APT 2308
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43604-1555
Mailing Address - Country:US
Mailing Address - Phone:567-318-9604
Mailing Address - Fax:567-318-9604
Practice Address - Street 1:200 N SAINT CLAIR ST APT 2308
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43604-1555
Practice Address - Country:US
Practice Address - Phone:567-318-9604
Practice Address - Fax:567-318-9604
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-08-23
Last Update Date:2025-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385HR2060XRespite Care FacilityRespite CareRespite Care, Intellectual and/or Developmental Disabilities, Child
No251S00000XAgenciesCommunity/Behavioral Health