Healthcare Provider Details

I. General information

NPI: 1437873452
Provider Name (Legal Business Name): COZY HORIZONS SUPPORTED LIVING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/03/2022
Last Update Date: 10/03/2022
Certification Date: 10/03/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7918 JONES BRANCH DR STE 400
MC LEAN VA
22102-3319
US

IV. Provider business mailing address

7918 JONES BRANCH DR STE 400
MC LEAN VA
22102-3319
US

V. Phone/Fax

Practice location:
  • Phone: 703-946-1664
  • Fax: 703-894-3351
Mailing address:
  • Phone: 703-946-1664
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: MOSUN OLUSANYA
Title or Position: OWNER/ADMINISTRATOR
Credential:
Phone: 301-437-3550