=====================================================
General NPI Number Information
=====================================================
NPI Number | 1285067025
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | COSY HOMES, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/15/2013
-----------------------------------------------------
Last Update Date | 08/15/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1722 MADISON ST
-----------------------------------------------------
City | HOLLYWOOD
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33020-5537
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 954-923-1726
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1722 MADISON ST
-----------------------------------------------------
City | HOLLYWOOD
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33020-5537
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 954-923-1726
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ADMINISTRATOR
-----------------------------------------------------
Name | MRS. MILA GOLDIN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 305-924-3863
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3104A0625X
-----------------------------------------------------
Taxonomy Name | Assisted Living Facility (Mental Illness)
-----------------------------------------------------
License Number | AL5026
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------