Healthcare Provider Details

I. General information

NPI: 1013368539
Provider Name (Legal Business Name): COG HOME HEALTH SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/27/2016
Last Update Date: 11/28/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9151 ESTATE THOMAS FOOTHILLS PROFESSIONAL BUILDING SUITE 206
ST. THOMAS VI
00802-4567
US

IV. Provider business mailing address

9151 ESTATE THOMAS FOOTHILLS PROFESSIONAL BUILDING SUITE 206
ST. THOMAS VI
00802-4567
US

V. Phone/Fax

Practice location:
  • Phone: 340-779-2663
  • Fax: 340-779-2443
Mailing address:
  • Phone: 340-779-4663
  • Fax: 340-779-2443

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: KIM T JEROME
Title or Position: DIRECTOR OF HOME HEALTH SERVICES
Credential:
Phone: 340-779-2663