Provider Demographics
NPI:1902118862
Name:HEAD2TOE HEALTHCARE LLC
Entity Type:Organization
Organization Name:HEAD2TOE HEALTHCARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DEANNA
Authorized Official - Middle Name:R
Authorized Official - Last Name:TOLMAN
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:303-627-1400
Mailing Address - Street 1:14901 E HAMPDEN AVE
Mailing Address - Street 2:SUITE 140
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80014-5065
Mailing Address - Country:US
Mailing Address - Phone:303-627-1400
Mailing Address - Fax:866-893-1180
Practice Address - Street 1:14901 E HAMPDEN AVE
Practice Address - Street 2:SUITE 140
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80014-5065
Practice Address - Country:US
Practice Address - Phone:303-627-1400
Practice Address - Fax:866-893-1180
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-08
Last Update Date:2014-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO103681261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO71704540Medicaid
COCOA102994Medicare PIN