Healthcare Provider Details

I. General information

NPI: 1992039382
Provider Name (Legal Business Name): COOGAN CAREGIVERS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/01/2009
Last Update Date: 10/01/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5550 STERRETT PL SUITE 309
COLUMBIA MD
21044-2628
US

IV. Provider business mailing address

5550 STERRETT PL SUITE 309
COLUMBIA MD
21044-2628
US

V. Phone/Fax

Practice location:
  • Phone: 410-715-9175
  • Fax: 410-715-9176
Mailing address:
  • Phone: 410-715-9175
  • Fax: 410-715-9176

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License NumberR2424
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code333300000X
TaxonomyEmergency Response System Companies
License NumberR2424
License Number StateMD

VIII. Authorized Official

Name: MRS. KATHRYN C PARKS
Title or Position: PRESIDENT/CEO
Credential: C.S.A.
Phone: 410-715-9175