Provider Demographics
NPI:1831336304
Name:TOMODACHI SERVICE PROVIDER CORPORATION
Entity type:Organization
Organization Name:TOMODACHI SERVICE PROVIDER CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:BRODRICK
Authorized Official - Middle Name:
Authorized Official - Last Name:ROBERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-385-0006
Mailing Address - Street 1:5918 SCHROEDER RD APT 23
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77021-3506
Mailing Address - Country:US
Mailing Address - Phone:713-385-0006
Mailing Address - Fax:
Practice Address - Street 1:5918 SCHROEDER RD APT 23
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77021-3506
Practice Address - Country:US
Practice Address - Phone:713-385-0006
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-20
Last Update Date:2009-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services