Provider Demographics
NPI:1568114817
Name:COSMETICARE RETREAT, LLC
Entity Type:Organization
Organization Name:COSMETICARE RETREAT, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RN, OWNER
Authorized Official - Prefix:
Authorized Official - First Name:QUANASHA
Authorized Official - Middle Name:
Authorized Official - Last Name:SMALL
Authorized Official - Suffix:
Authorized Official - Credentials:RN,MSN
Authorized Official - Phone:832-499-7330
Mailing Address - Street 1:9910 CHANNEL SET WAY
Mailing Address - Street 2:
Mailing Address - City:ROSHARON
Mailing Address - State:TX
Mailing Address - Zip Code:77583-1023
Mailing Address - Country:US
Mailing Address - Phone:832-499-7330
Mailing Address - Fax:
Practice Address - Street 1:9910 CHANNEL SET WAY
Practice Address - Street 2:
Practice Address - City:ROSHARON
Practice Address - State:TX
Practice Address - Zip Code:77583-1023
Practice Address - Country:US
Practice Address - Phone:832-499-7330
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-18
Last Update Date:2022-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care