=====================================================
General NPI Number Information
=====================================================
NPI Number | 1275010191
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | COSIVA TRANSPORTATION
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/24/2018
-----------------------------------------------------
Last Update Date | 07/24/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 23334 WILLIAMS AVE
-----------------------------------------------------
City | EUCLID
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44123-1525
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 216-233-1820
-----------------------------------------------------
Fax | 216-472-8162
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 23334 WILLIAMS AVE
-----------------------------------------------------
City | EUCLID
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44123-1525
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 216-233-1820
-----------------------------------------------------
Fax | 216-472-8162
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | EXECUTIVE DIRECTOR
-----------------------------------------------------
Name | MS. SHEREE LAVETTE STARR
-----------------------------------------------------
Credential | RN
-----------------------------------------------------
Telephone | 216-233-1820
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------