Provider Demographics
NPI:1083491948
Name:COOKS HOME ASSISTANCE CARE, LLC
Entity Type:Organization
Organization Name:COOKS HOME ASSISTANCE CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:COURTNEY
Authorized Official - Middle Name:DEVON
Authorized Official - Last Name:COOKS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:219-951-0887
Mailing Address - Street 1:8300 BROADWAY STE F1
Mailing Address - Street 2:
Mailing Address - City:MERRILLVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46410-6269
Mailing Address - Country:US
Mailing Address - Phone:219-951-0887
Mailing Address - Fax:
Practice Address - Street 1:8300 BROADWAY STE F1
Practice Address - Street 2:
Practice Address - City:MERRILLVILLE
Practice Address - State:IN
Practice Address - Zip Code:46410-6269
Practice Address - Country:US
Practice Address - Phone:219-777-0917
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-13
Last Update Date:2023-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care