Provider Demographics
NPI:1376686402
Name:COOK'S HOME HEALTH CENTER, INC
Entity Type:Organization
Organization Name:COOK'S HOME HEALTH CENTER, INC
Other - Org Name:COOK & MACDONALD MEDICAL SUPPLY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:A
Authorized Official - Last Name:MACDONALD
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:860-283-4424
Mailing Address - Street 1:81 HILLSIDE AVE
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:CT
Mailing Address - Zip Code:06782-2305
Mailing Address - Country:US
Mailing Address - Phone:860-283-4424
Mailing Address - Fax:860-283-6667
Practice Address - Street 1:81 HILLSIDE AVE
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:CT
Practice Address - Zip Code:06782-2305
Practice Address - Country:US
Practice Address - Phone:860-283-4424
Practice Address - Fax:860-283-6667
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-15
Last Update Date:2008-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BN1400XSuppliersDurable Medical Equipment & Medical SuppliesNursing Facility Supplies
No332U00000XSuppliersHome Delivered Meals
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
No347C00000XTransportation ServicesPrivate Vehicle
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004086717Medicaid
CT004086717Medicaid