Provider Demographics
NPI:1073107710
Name:TOKACH, ROSS LOUIS
Entity Type:Individual
Prefix:
First Name:ROSS
Middle Name:LOUIS
Last Name:TOKACH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1638 TIMBERHAVEN DR S
Mailing Address - Street 2:
Mailing Address - City:MANDAN
Mailing Address - State:ND
Mailing Address - Zip Code:58554-8703
Mailing Address - Country:US
Mailing Address - Phone:701-426-4209
Mailing Address - Fax:
Practice Address - Street 1:1638 TIMBERHAVEN DR S
Practice Address - Street 2:
Practice Address - City:MANDAN
Practice Address - State:ND
Practice Address - Zip Code:58554-8703
Practice Address - Country:US
Practice Address - Phone:701-426-4209
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-23
Last Update Date:2021-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant