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General NPI Number Information
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NPI Number | 1659927325
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Entity Type | Organization
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Legal Business Name | COBY CARES CORPORATION
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Dates
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Enumeration Date | 08/17/2019
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Last Update Date | 08/17/2019
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Provider Practice Location Address
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Address Line | 1754 BARNSTABLE RD
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City | WELLINGTON
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State | FL
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Zip | 33414-6143
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Country | US
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Telephone | 904-236-0014
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 19644
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City | WEST PALM BEACH
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State | FL
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Zip | 33416-9644
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Country | US
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Telephone | 904-236-0014
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | JU'COBY TODD
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Credential |
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Telephone | 904-236-0014
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320600000X
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Taxonomy Name | Intellectual and/or Developmental Disabilities Residential Treatment Facility
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License Number |
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License Number State |
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