=====================================================
General NPI Number Information
=====================================================
NPI Number | 1194290726
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | COS WE CARE ADULT DAY SERVICES LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/10/2018
-----------------------------------------------------
Last Update Date | 04/06/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1515 S. WAYNE RD
-----------------------------------------------------
City | WESTLAND
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48186-5436
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 734-218-0740
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1515 S WAYNE RD
-----------------------------------------------------
City | WESTLAND
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48186-5436
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 734-218-0740
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER / AUTHORIZED OFFICIAL
-----------------------------------------------------
Name | NKIRU IBEGBU
-----------------------------------------------------
Credential | RN
-----------------------------------------------------
Telephone | 734-218-0740
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------