Provider Demographics
NPI:1083165096
Name:COOK'S HOME HEALTH CENTER, INC.
Entity Type:Organization
Organization Name:COOK'S HOME HEALTH CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:DIANE
Authorized Official - Last Name:MACDONALD
Authorized Official - Suffix:
Authorized Official - Credentials:RN ADM
Authorized Official - Phone:860-283-8208
Mailing Address - Street 1:81 HILLSIDE AVENUE
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:CT
Mailing Address - Zip Code:06782-0275
Mailing Address - Country:US
Mailing Address - Phone:860-283-8208
Mailing Address - Fax:860-283-6667
Practice Address - Street 1:81 HILLSIDE AVENUE
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:CT
Practice Address - Zip Code:06782-0275
Practice Address - Country:US
Practice Address - Phone:860-283-8208
Practice Address - Fax:860-283-6667
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-14
Last Update Date:2016-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332U00000X, 347C00000X
CT333300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332U00000XSuppliersHome Delivered Meals
No333300000XSuppliersEmergency Response System Companies
No347C00000XTransportation ServicesPrivate Vehicle
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTC008045866Medicaid