Provider Demographics
NPI: | 1952537409 |
---|---|
Name: | TATO HEALTHCARE AGENCY, INC. |
Entity Type: | Organization |
Organization Name: | TATO HEALTHCARE AGENCY, INC. |
Other - Org Name: | TATO HEALTHCARE AGENCY INC. |
Other - Org Type: | Doing Business As |
Authorized Official - Title/Position: | PRESIDENT/MANAGER |
Authorized Official - Prefix: | MS |
Authorized Official - First Name: | ROSE |
Authorized Official - Middle Name: | K |
Authorized Official - Last Name: | BROWN |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 651-298-1111 |
Mailing Address - Street 1: | 325 CEDAR ST |
Mailing Address - Street 2: | DEGREE OF HONOR BLDG., SUITE # 305 |
Mailing Address - City: | SAINT PAUL |
Mailing Address - State: | MN |
Mailing Address - Zip Code: | 55101-1015 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 651-298-1111 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 325 CEDAR ST |
Practice Address - Street 2: | DEGREE OF HONOR BLDG., SUITE # 305 |
Practice Address - City: | SAINT PAUL |
Practice Address - State: | MN |
Practice Address - Zip Code: | 55101-1015 |
Practice Address - Country: | US |
Practice Address - Phone: | 651-298-1111 |
Practice Address - Fax: | |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2009-06-10 |
Last Update Date: | 2009-06-10 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
MN | 163W00000X, 163WC1600X, 163WH0200X, 163WR0400X, 164W00000X, 251E00000X, 251F00000X, 251J00000X, 253J00000X, 253Z00000X, 3747A0650X, 3747P1801X, 374U00000X, 376J00000X, 376K00000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 251E00000X | Agencies | Home Health | ||
No | 163W00000X | Nursing Service Providers | Registered Nurse | Group - Single Specialty | |
No | 163WC1600X | Nursing Service Providers | Registered Nurse | Continuing Education/Staff Development | Group - Single Specialty |
No | 163WH0200X | Nursing Service Providers | Registered Nurse | Home Health | Group - Single Specialty |
No | 163WR0400X | Nursing Service Providers | Registered Nurse | Rehabilitation | Group - Single Specialty |
No | 164W00000X | Nursing Service Providers | Licensed Practical Nurse | Group - Single Specialty | |
No | 251F00000X | Agencies | Home Infusion | ||
No | 251J00000X | Agencies | Nursing Care | ||
No | 253J00000X | Agencies | Foster Care Agency | Group - Single Specialty | |
No | 253Z00000X | Agencies | In Home Supportive Care | Group - Single Specialty | |
No | 3747A0650X | Nursing Service Related Providers | Technician | Attendant Care Provider | Group - Single Specialty |
No | 3747P1801X | Nursing Service Related Providers | Technician | Personal Care Attendant | Group - Single Specialty |
No | 374U00000X | Nursing Service Related Providers | Home Health Aide | Group - Single Specialty | |
No | 376J00000X | Nursing Service Related Providers | Homemaker | Group - Single Specialty | |
No | 376K00000X | Nursing Service Related Providers | Nurse's Aide | Group - Single Specialty |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
MN | 9963472 | Other | UCARE |
MN | 9963472 | Other | BLUS PLUS |
MN | 9963472 | Medicaid | |
MN | 9963472 | Medicaid |