MEDICARE: COSBYS ANGELS IN ACTION, LLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	376K00000X	Nurse's Aide

General Provider Information

NPI Number	:	1740145416
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COSBYS ANGELS IN ACTION, LLC

Provider Business Mailing Address
First Line	:	1917 MEADOWBROOK RD
Second Line	:
City	:	JACKSON
State	:	MS
Zip	:	39211-6523
Country	:	US
Telephone Number	:	601-954-1208
Fax Number	:	601-372-2004

Provider Business Practice Location Address
First Line	:	1917 MEADOWBROOK RD
Second Line	:
City	:	JACKSON
State	:	MS
Zip	:	39211-6523
Country	:	US
Telephone Number	:	601-954-1208
Fax Number	:	601-372-2004

Authorized Official
Title or Position	:	CEO/OWNER
Name	:	MS. LEILA ELLEN COSBY
Credential	:
Telephone Number	:	601-954-1208

Provider Enumeration Date	:	12/16/2025
Last Update Date	:	12/16/2025

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