Provider Demographics
NPI:1346904166
Name:ROOSTER BRANDS, INC.
Entity Type:Organization
Organization Name:ROOSTER BRANDS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER / OPERATOR
Authorized Official - Prefix:
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:
Authorized Official - Last Name:KOGUT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:708-228-3365
Mailing Address - Street 1:4144 CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33711-1113
Mailing Address - Country:US
Mailing Address - Phone:727-284-7700
Mailing Address - Fax:
Practice Address - Street 1:4144 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33711-1113
Practice Address - Country:US
Practice Address - Phone:727-284-7700
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-27
Last Update Date:2021-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care