Healthcare Provider Details

I. General information

NPI: 1811348600
Provider Name (Legal Business Name): COG HOME HEALTH SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/23/2016
Last Update Date: 11/28/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4500 SUNNY ISLE SUITE 301
CHRISTIANSTED VI
00820-4493
US

IV. Provider business mailing address

4500 SUNNY ISLE SUITE 301
CHRISTIANSTED VI
00820-4493
US

V. Phone/Fax

Practice location:
  • Phone: 340-718-2665
  • Fax:
Mailing address:
  • Phone: 340-718-2665
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number StateVI

VIII. Authorized Official

Name: KIM T JEROME
Title or Position: DIRECTOR OF HOME HEALTH SERVICES
Credential: RN
Phone: 340-718-2665