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General NPI Number Information
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NPI Number | 1194442814
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Entity Type | Organization
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Legal Business Name | COTHRAN INNOVATIONS LLC
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Dates
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Enumeration Date | 10/24/2022
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Last Update Date | 12/10/2025
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Provider Practice Location Address
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Address Line | 120 CAPCOM AVE STE 103
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City | WAKE FOREST
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State | NC
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Zip | 27587-6537
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Country | US
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Telephone | 708-543-4310
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Fax | 919-457-1492
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Provider Business Mailing Address
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Address Line | 120 CAPCOM AVE STE 103
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City | WAKE FOREST
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State | NC
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Zip | 27587-6537
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Country | US
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Telephone | 708-543-4310
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Fax | 919-457-1492
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Authorized Official
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Title or Position | OWNER/ AGENCY DIRECTOR
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Name | SHAWN MICHEAL COTHRAN
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Credential |
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Telephone | 708-543-4310
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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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