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General NPI Number Information
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NPI Number | 1083491948
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Entity Type | Organization
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Legal Business Name | COOKS HOME ASSISTANCE CARE, LLC
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Dates
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Enumeration Date | 09/13/2023
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Last Update Date | 09/13/2023
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Provider Practice Location Address
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Address Line | 8300 BROADWAY STE F1
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City | MERRILLVILLE
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State | IN
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Zip | 46410-6269
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Country | US
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Telephone | 219-777-0917
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Fax |
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Provider Business Mailing Address
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Address Line | 8300 BROADWAY STE F1
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City | MERRILLVILLE
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State | IN
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Zip | 46410-6269
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Country | US
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Telephone | 219-951-0887
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Fax |
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Authorized Official
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Title or Position | OWNER/ADMINISTRATOR
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Name | COURTNEY DEVON COOKS
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Credential |
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Telephone | 219-951-0887
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number |
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License Number State |
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