Provider Demographics
NPI:1114619590
Name:KOSHIP INDUSTRIES
Entity Type:Organization
Organization Name:KOSHIP INDUSTRIES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER,
Authorized Official - Prefix:
Authorized Official - First Name:KOBY
Authorized Official - Middle Name:MATTHEW
Authorized Official - Last Name:SHIPMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:843-998-1223
Mailing Address - Street 1:1150 TWISTED HICKORY RD
Mailing Address - Street 2:
Mailing Address - City:ELIZABETHTOWN
Mailing Address - State:NC
Mailing Address - Zip Code:28337-5202
Mailing Address - Country:US
Mailing Address - Phone:843-998-1223
Mailing Address - Fax:
Practice Address - Street 1:1150 TWISTED HICKORY RD
Practice Address - Street 2:
Practice Address - City:ELIZABETHTOWN
Practice Address - State:NC
Practice Address - Zip Code:28337-5202
Practice Address - Country:US
Practice Address - Phone:843-998-1223
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-23
Last Update Date:2023-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health