MEDICARE: COZY HORIZONS SUPPORTED LIVING

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	251S00000X	Community/Behavioral Health Agency
2	253Z00000X	In Home Supportive Care Agency
3	251C00000X	Developmentally Disabled Services Day Training Agency

General Provider Information

NPI Number	:	1437873452
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COZY HORIZONS SUPPORTED LIVING

Provider Business Mailing Address
First Line	:	7918 JONES BRANCH DR STE 400
Second Line	:
City	:	MC LEAN
State	:	VA
Zip	:	22102-3319
Country	:	US
Telephone Number	:	703-946-1664
Fax Number	:

Provider Business Practice Location Address
First Line	:	7918 JONES BRANCH DR STE 400
Second Line	:
City	:	MC LEAN
State	:	VA
Zip	:	22102-3319
Country	:	US
Telephone Number	:	703-946-1664
Fax Number	:	703-894-3351

Authorized Official
Title or Position	:	OWNER/ADMINISTRATOR
Name	:	MOSUN OLUSANYA
Credential	:
Telephone Number	:	301-437-3550

Provider Enumeration Date	:	10/03/2022
Last Update Date	:	10/03/2022

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