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NPI Code Detail

MEDICARE: MRS. SHARON KAY COYKENDALL COTA

MEDICARE: MRS. SHARON KAY COYKENDALL COTA
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
1310400000XAssisted Living FacilityL1129555MI

General Provider Information

NPI Number : 1952511248
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. SHARON KAY COYKENDALL COTA
Provider Business Mailing Address
First Line : 2757 RICHMOND ST NW
Second Line :
City : GRAND RAPIDS
State : MI
Zip : 49504-2332
Country : US
Telephone Number : 616-453-1774
Fax Number :
Provider Business Practice Location Address
First Line : 2161 LEONARD ST NW
Second Line :
City : GRAND RAPIDS
State : MI
Zip : 49504-3829
Country : US
Telephone Number : 616-453-7715
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/23/2007
Last Update Date : 07/08/2007

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