Healthcare Provider Details

I. General information

NPI: 1700239712
Provider Name (Legal Business Name): COZY CORNER ADULT DAY CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/14/2016
Last Update Date: 07/14/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2785 PENNSYLVANIA AVE
DUBUQUE IA
52001-5460
US

IV. Provider business mailing address

2785 PENNSYLVANIA AVE
DUBUQUE IA
52001-5460
US

V. Phone/Fax

Practice location:
  • Phone: 563-690-6900
  • Fax: 563-552-7178
Mailing address:
  • Phone: 563-690-6900
  • Fax: 563-552-7178

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License NumberADS109
License Number StateIA

VIII. Authorized Official

Name: MARIKO WILBRICHT
Title or Position: ADMINISTRATOR
Credential:
Phone: 563-690-6900