Provider Demographics
NPI:1346648219
Name:TAKPOMO FOUNDATION
Entity Type:Organization
Organization Name:TAKPOMO FOUNDATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TUTSE
Authorized Official - Middle Name:
Authorized Official - Last Name:TONWE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:302-423-1118
Mailing Address - Street 1:640 S QUEEN ST
Mailing Address - Street 2:
Mailing Address - City:DOVER
Mailing Address - State:DE
Mailing Address - Zip Code:19904-3565
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:640 S QUEEN ST
Practice Address - Street 2:
Practice Address - City:DOVER
Practice Address - State:DE
Practice Address - Zip Code:19904-3565
Practice Address - Country:US
Practice Address - Phone:302-423-1118
Practice Address - Fax:302-734-4401
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-09
Last Update Date:2014-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty