Healthcare Provider Details

I. General information

NPI: 1740145416
Provider Name (Legal Business Name): COSBYS ANGELS IN ACTION, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/16/2025
Last Update Date: 12/16/2025
Certification Date: 12/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1917 MEADOWBROOK RD
JACKSON MS
39211-6523
US

IV. Provider business mailing address

1917 MEADOWBROOK RD
JACKSON MS
39211-6523
US

V. Phone/Fax

Practice location:
  • Phone: 601-954-1208
  • Fax: 601-372-2004
Mailing address:
  • Phone: 601-954-1208
  • Fax: 601-372-2004

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number
License Number State

VIII. Authorized Official

Name: MS. LEILA ELLEN COSBY
Title or Position: CEO/OWNER
Credential:
Phone: 601-954-1208