Provider Demographics
NPI:1710588504
Name:TOLLY CARE SERVICES INC
Entity Type:Organization
Organization Name:TOLLY CARE SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:OLUDOTUN
Authorized Official - Middle Name:OLUSESAN
Authorized Official - Last Name:FAJOBI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-712-6125
Mailing Address - Street 1:5411 WYALONG DR
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28227-7840
Mailing Address - Country:US
Mailing Address - Phone:704-712-6125
Mailing Address - Fax:
Practice Address - Street 1:4822 ALBEMARLE RD
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28205-6668
Practice Address - Country:US
Practice Address - Phone:704-712-6125
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-06
Last Update Date:2020-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care