Provider Demographics
NPI:1891376836
Name:COOSHA'E CARES
Entity Type:Organization
Organization Name:COOSHA'E CARES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ FOUNDER
Authorized Official - Prefix:DR
Authorized Official - First Name:SHANTAE
Authorized Official - Middle Name:
Authorized Official - Last Name:COPPOCK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:267-241-1161
Mailing Address - Street 1:501 S 63RD ST STE 1
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19143-1018
Mailing Address - Country:US
Mailing Address - Phone:267-507-0545
Mailing Address - Fax:
Practice Address - Street 1:501 S 63RD ST STE 1
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19143-1018
Practice Address - Country:US
Practice Address - Phone:267-507-0545
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-20
Last Update Date:2021-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No251E00000XAgenciesHome Health