Provider Demographics
NPI:1669850889
Name:COTTAGE OF HOPE LLC
Entity Type:Organization
Organization Name:COTTAGE OF HOPE LLC
Other - Org Name:COTTAGE OF HOPE AND WELLNESS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:YOW
Authorized Official - Last Name:GOFF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-622-3385
Mailing Address - Street 1:430 MAGNOLIA SQUARE CT
Mailing Address - Street 2:
Mailing Address - City:ABERDEEN
Mailing Address - State:NC
Mailing Address - Zip Code:28315-2228
Mailing Address - Country:US
Mailing Address - Phone:910-944-2255
Mailing Address - Fax:910-944-2255
Practice Address - Street 1:430 MAGNOLIA SQUARE CT
Practice Address - Street 2:
Practice Address - City:ABERDEEN
Practice Address - State:NC
Practice Address - Zip Code:28315-2228
Practice Address - Country:US
Practice Address - Phone:910-944-2255
Practice Address - Fax:910-944-2255
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-07
Last Update Date:2015-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies