Healthcare Provider Details

I. General information

NPI: 1225834773
Provider Name (Legal Business Name): KOZA CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/24/2025
Last Update Date: 02/24/2025
Certification Date: 02/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

225 MAIN ST
SPRINGFIELD OR
97477-5369
US

IV. Provider business mailing address

225 MAIN ST
SPRINGFIELD OR
97477-5369
US

V. Phone/Fax

Practice location:
  • Phone: 541-603-6771
  • Fax:
Mailing address:
  • Phone: 541-603-6771
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: CINDY KOZA
Title or Position: CEO
Credential:
Phone: 541-603-6771