Provider Demographics
NPI:1790327302
Name:COSMOS THERAPY SOLUTIONS, LLC
Entity Type:Organization
Organization Name:COSMOS THERAPY SOLUTIONS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KALEY
Authorized Official - Middle Name:RUTH
Authorized Official - Last Name:RADERMACHER
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW, CMHP
Authorized Official - Phone:406-207-7929
Mailing Address - Street 1:715 KENSINGTON AVE STE 14
Mailing Address - Street 2:
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59801-5700
Mailing Address - Country:US
Mailing Address - Phone:406-207-7929
Mailing Address - Fax:
Practice Address - Street 1:715 KENSINGTON AVE STE 14
Practice Address - Street 2:
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59801-5700
Practice Address - Country:US
Practice Address - Phone:406-207-7929
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-15
Last Update Date:2019-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT1194273730Medicaid