Healthcare Provider Details

I. General information

NPI: 1063667517
Provider Name (Legal Business Name): COSMIC HOME HEALTHCARE INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/25/2008
Last Update Date: 10/09/2024
Certification Date: 10/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

204 CORKY BOYD AVE
WILLS POINT TX
75169-2811
US

IV. Provider business mailing address

204 CORKY BOYD AVE
WILLS POINT TX
75169-2811
US

V. Phone/Fax

Practice location:
  • Phone: 972-248-7848
  • Fax: 972-474-9115
Mailing address:
  • Phone: 972-248-7848
  • Fax: 972-474-9115

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: TYLER JEFFREY
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 903-703-9622