Healthcare Provider Details

I. General information

NPI: 1487134169
Provider Name (Legal Business Name): COSIVA HOME HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/21/2018
Last Update Date: 08/21/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23334 WILLIAMS AVE
EUCLID OH
44123-1525
US

IV. Provider business mailing address

23334 WILLIAMS AVE
EUCLID OH
44123-1525
US

V. Phone/Fax

Practice location:
  • Phone: 216-233-1820
  • Fax: 216-472-8162
Mailing address:
  • Phone: 216-233-1820
  • Fax: 216-472-8162

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number318171
License Number StateOH

VIII. Authorized Official

Name: MS. SHEREE LAVETTE STARR
Title or Position: EXECUTIVE
Credential: RN
Phone: 216-233-1820