Provider Demographics
NPI:1508119801
Name:COOGAN CAREGIVERS LLC
Entity Type:Organization
Organization Name:COOGAN CAREGIVERS LLC
Other - Org Name:HOMEWATCH CAREGIVERS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:
Authorized Official - First Name:KATHRYN
Authorized Official - Middle Name:COOGAN
Authorized Official - Last Name:PARKS
Authorized Official - Suffix:
Authorized Official - Credentials:CSA
Authorized Official - Phone:410-715-9175
Mailing Address - Street 1:3440 ELLICOTT CENTER DR
Mailing Address - Street 2:SUITE 101
Mailing Address - City:ELLICOTT CITY
Mailing Address - State:MD
Mailing Address - Zip Code:21043-4155
Mailing Address - Country:US
Mailing Address - Phone:410-715-9175
Mailing Address - Fax:410-715-9176
Practice Address - Street 1:3440 ELLICOTT CENTER DR
Practice Address - Street 2:SUITE 101
Practice Address - City:ELLICOTT CITY
Practice Address - State:MD
Practice Address - Zip Code:21043-4155
Practice Address - Country:US
Practice Address - Phone:410-715-9175
Practice Address - Fax:410-715-9176
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-24
Last Update Date:2017-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR2424251J00000X, 253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No251J00000XAgenciesNursing Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD288903000Medicaid