Provider Demographics
NPI:1861272544
Name:THE T.A. COOK AGENCY, LLC
Entity type:Organization
Organization Name:THE T.A. COOK AGENCY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:TREVON
Authorized Official - Middle Name:
Authorized Official - Last Name:COOK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:202-873-0398
Mailing Address - Street 1:712 H ST NE UNIT 669
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20002-3627
Mailing Address - Country:US
Mailing Address - Phone:202-873-0398
Mailing Address - Fax:
Practice Address - Street 1:1535 MORRIS RD SE
Practice Address - Street 2:STE 302
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20020
Practice Address - Country:US
Practice Address - Phone:202-873-0398
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-02
Last Update Date:2023-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No385H00000XRespite Care FacilityRespite Care
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)