MEDICARE: COSMIC HOME HEALTHCARE INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251E00000X	Home Health Agency

General Provider Information

NPI Number	:	1063667517
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COSMIC HOME HEALTHCARE INC.

Provider Business Mailing Address
First Line	:	204 CORKY BOYD AVE
Second Line	:
City	:	WILLS POINT
State	:	TX
Zip	:	75169-2811
Country	:	US
Telephone Number	:	972-248-7848
Fax Number	:	972-474-9115

Provider Business Practice Location Address
First Line	:	204 CORKY BOYD AVE
Second Line	:
City	:	WILLS POINT
State	:	TX
Zip	:	75169-2811
Country	:	US
Telephone Number	:	972-248-7848
Fax Number	:	972-474-9115

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	TYLER JEFFREY
Credential	:
Telephone Number	:	903-703-9622

Provider Enumeration Date	:	11/25/2008
Last Update Date	:	10/09/2024

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