Provider Demographics
NPI:1437496007
Name:TONIC
Entity Type:Organization
Organization Name:TONIC
Other - Org Name:NICOTOS
Other - Org Type:Other Name
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:NICODEMUS
Authorized Official - Middle Name:
Authorized Official - Last Name:TOSAH
Authorized Official - Suffix:
Authorized Official - Credentials:LPN
Authorized Official - Phone:614-556-6903
Mailing Address - Street 1:4019 BURNELL CIR W
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43224-1881
Mailing Address - Country:US
Mailing Address - Phone:614-556-6903
Mailing Address - Fax:
Practice Address - Street 1:4019 BURNELL CIR W
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43224-1881
Practice Address - Country:US
Practice Address - Phone:614-556-6903
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-15
Last Update Date:2013-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN151581-M-IV251J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care