Provider Demographics
NPI:1588174080
Name:TOLLIVER BROTHER
Entity type:Organization
Organization Name:TOLLIVER BROTHER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:VIOLA
Authorized Official - Middle Name:
Authorized Official - Last Name:TOLLIVER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:646-204-8254
Mailing Address - Street 1:4815 E STARFLOWER ST
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85756-5159
Mailing Address - Country:US
Mailing Address - Phone:646-204-8254
Mailing Address - Fax:
Practice Address - Street 1:2815 ALBION ST
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43610-1222
Practice Address - Country:US
Practice Address - Phone:646-204-8254
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-10
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health