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General NPI Number Information
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NPI Number | 1902253057
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Entity Type | Organization
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Legal Business Name | GENE COOK SUPPORTS, LLC
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Dates
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Enumeration Date | 05/18/2016
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Last Update Date | 05/21/2020
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Provider Practice Location Address
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Address Line | 108 2ND AVE
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City | SCOTTDALE
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State | PA
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Zip | 15683-2105
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Country | US
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Telephone | 724-217-5479
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Fax | 724-220-5194
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Provider Business Mailing Address
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Address Line | 108 2ND AVE
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City | SCOTTDALE
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State | PA
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Zip | 15683-2105
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Country | US
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Telephone | 724-217-5479
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Fax | 724-220-5194
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Authorized Official
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Title or Position | OWNER/ CEO
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Name | MR. EUGENE THOMAS COOK SR.
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Credential | OWNER/ CEO
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Telephone | 724-217-5479
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251J00000X
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Taxonomy Name | Nursing Care Agency
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License Number |
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License Number State | PA
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