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General NPI Number Information
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NPI Number | 1811673189
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Entity Type | Organization
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Legal Business Name | KUKU 4 COCO BEACH, LLC
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Dates
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Enumeration Date | 06/22/2023
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Last Update Date | 06/22/2023
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Provider Practice Location Address
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Address Line | 97 W OAK AVE
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City | PANAMA CITY
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State | FL
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Zip | 32401-2735
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Country | US
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Telephone | 850-661-0362
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Fax |
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Provider Business Mailing Address
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Address Line | 5153 HOLLY FERN TRCE
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City | TALLAHASSEE
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State | FL
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Zip | 32312-7583
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Country | US
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Telephone | 850-251-2718
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MR. KURT BOWMAN
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Credential |
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Telephone | 850-661-0362
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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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