Provider Demographics
NPI:1275983850
Name:COSBY CARES HEALTHCARE SERVICE LLC
Entity Type:Organization
Organization Name:COSBY CARES HEALTHCARE SERVICE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CATRECE
Authorized Official - Middle Name:
Authorized Official - Last Name:COSBY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-718-1655
Mailing Address - Street 1:1409 WASHINGTON AVE
Mailing Address - Street 2:SUITE 210
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63103-1936
Mailing Address - Country:US
Mailing Address - Phone:844-532-2737
Mailing Address - Fax:314-833-5819
Practice Address - Street 1:1409 WASHINGTON AVE
Practice Address - Street 2:SUITE 210
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63103-1936
Practice Address - Country:US
Practice Address - Phone:844-532-2737
Practice Address - Fax:314-833-5819
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-15
Last Update Date:2016-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care