=====================================================
General NPI Number Information
=====================================================
NPI Number | 1407234636
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | COOL NURSES OF AMERICA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/07/2015
-----------------------------------------------------
Last Update Date | 05/07/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 605 CASTLEBROOK DR
-----------------------------------------------------
City | SAINT PETERS
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 63376-7727
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 314-556-9830
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 605 CASTLEBROOK DR
-----------------------------------------------------
City | SAINT PETERS
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 63376-7727
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 314-556-9830
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/MANAGER
-----------------------------------------------------
Name | LAPORTCIA L BOLDEN
-----------------------------------------------------
Credential | RN
-----------------------------------------------------
Telephone | 314-556-9830
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number | LC001418771
-----------------------------------------------------
License Number State | MO
-----------------------------------------------------