Healthcare Provider Details

I. General information

NPI: 1952625428
Provider Name (Legal Business Name): COOKS HEALTHCARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/26/2010
Last Update Date: 01/16/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

611 MOSS HILL DR
NEW ALBANY MS
38652-3212
US

IV. Provider business mailing address

611 MOSS HILL DR
NEW ALBANY MS
38652-3212
US

V. Phone/Fax

Practice location:
  • Phone: 662-534-6789
  • Fax: 662-534-6763
Mailing address:
  • Phone: 662-534-6789
  • Fax: 662-534-6763

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174200000X
TaxonomyMeals Provider
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code344600000X
TaxonomyTaxi
License Number
License Number State

VIII. Authorized Official

Name: MRS. CALRENEASE COOK
Title or Position: OWNER/ MANAGER
Credential: LPN
Phone: 662-534-6789