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General NPI Number Information
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NPI Number | 1003247925
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Entity Type | Organization
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Legal Business Name | COOL WATERS, LLC
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Dates
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Enumeration Date | 12/02/2013
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Last Update Date | 08/19/2016
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Provider Practice Location Address
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Address Line | 4601 LOCUST LN STE 305
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City | HARRISBURG
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State | PA
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Zip | 17109-4446
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Country | US
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Telephone | 717-545-2920
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Fax |
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Provider Business Mailing Address
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Address Line | 4601 LOCUST LN STE 305
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City | HARRISBURG
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State | PA
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Zip | 17109-4446
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Country | US
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Telephone | 717-545-2920
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Fax |
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Authorized Official
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Title or Position | DIRECTOR OF OPERAATIONS AND FINANCE
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Name | ESTER MBAYA
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Credential |
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Telephone | 858-245-8327
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number | 06310501
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License Number State | PA
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