Provider Demographics
NPI:1881068062
Name:TOC, INC
Entity type:Organization
Organization Name:TOC, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SEC/TREAS
Authorized Official - Prefix:
Authorized Official - First Name:TRACY
Authorized Official - Middle Name:LAVON
Authorized Official - Last Name:MARTINEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:970-874-6115
Mailing Address - Street 1:108 W 2ND ST
Mailing Address - Street 2:
Mailing Address - City:DELTA
Mailing Address - State:CO
Mailing Address - Zip Code:81416-1802
Mailing Address - Country:US
Mailing Address - Phone:970-874-6115
Mailing Address - Fax:
Practice Address - Street 1:1100 E MAIN ST STE A
Practice Address - Street 2:
Practice Address - City:MONTROSE
Practice Address - State:CO
Practice Address - Zip Code:81401-4063
Practice Address - Country:US
Practice Address - Phone:970-249-6080
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TOC, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-11-25
Last Update Date:2015-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO04H133253Z00000X
CO04O628251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO74731581Medicaid