MEDICARE: COTHRAN INNOVATIONS LLC

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	253Z00000X	In Home Supportive Care Agency

General Provider Information

NPI Number	:	1831924893
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COTHRAN INNOVATIONS LLC

Provider Business Mailing Address
First Line	:	9437 NIGHT HARBOR DR
Second Line	:
City	:	LELAND
State	:	NC
Zip	:	28451-9596
Country	:	US
Telephone Number	:	919-213-0733
Fax Number	:

Provider Business Practice Location Address
First Line	:	4624 CAROLINA BEACH ROAD
Second Line	:	SUITE 120
City	:	WILMINGTON
State	:	NC
Zip	:	28412
Country	:	US
Telephone Number	:	919-554-2223
Fax Number	:	919-457-1492

Authorized Official
Title or Position	:	OWNER/ AGENCY DIRECTOR
Name	:	SHAWN MICHEAL COTHRAN
Credential	:
Telephone Number	:	708-543-4310

Provider Enumeration Date	:	09/07/2024
Last Update Date	:	12/12/2025

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Directions to “COTHRAN INNOVATIONS LLC ” Practice Location

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