Provider Demographics
NPI:1407893225
Name:COOLEY ENTERPRISES, INC.
Entity Type:Organization
Organization Name:COOLEY ENTERPRISES, INC.
Other - Org Name:HOMEWATCH CAREGIVERS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PHILLIP
Authorized Official - Middle Name:ALLEN
Authorized Official - Last Name:COOLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-503-4660
Mailing Address - Street 1:8301 UNIVERSITY EXEC PARK DR
Mailing Address - Street 2:SUITE 102
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28262-3355
Mailing Address - Country:US
Mailing Address - Phone:704-503-4660
Mailing Address - Fax:704-503-4665
Practice Address - Street 1:8301 UNIVERSITY EXEC PARK DR
Practice Address - Street 2:SUITE 102
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28262-3355
Practice Address - Country:US
Practice Address - Phone:704-503-4660
Practice Address - Fax:704-503-4665
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCHC1947251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6600744Medicaid
NC3409284Medicaid