Healthcare Provider Details

I. General information

NPI: 1346904166
Provider Name (Legal Business Name): ROOSTER BRANDS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/27/2021
Last Update Date: 12/18/2025
Certification Date: 12/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5635 49TH ST N
ST PETERSBURG FL
33709-2105
US

IV. Provider business mailing address

5635 49TH ST N
ST PETERSBURG FL
33709-2105
US

V. Phone/Fax

Practice location:
  • Phone: 727-284-7700
  • Fax:
Mailing address:
  • Phone: 727-284-7700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: SCOTT KOGUT
Title or Position: OWNER / OPERATOR
Credential:
Phone: 708-228-3365