Provider Demographics
NPI:1952503708
Name:TAMMY AND MARTY'S COZY ADULT CARE HOME II LLC
Entity Type:Organization
Organization Name:TAMMY AND MARTY'S COZY ADULT CARE HOME II LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER OPERATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:MARTIN
Authorized Official - Last Name:REDMOND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:719-566-1189
Mailing Address - Street 1:523 W COKEDALE DR
Mailing Address - Street 2:
Mailing Address - City:PUEBLO WEST
Mailing Address - State:CO
Mailing Address - Zip Code:81007-5117
Mailing Address - Country:US
Mailing Address - Phone:719-566-1189
Mailing Address - Fax:719-566-1189
Practice Address - Street 1:523 W COKEDALE DR
Practice Address - Street 2:
Practice Address - City:PUEBLO WEST
Practice Address - State:CO
Practice Address - Zip Code:81007-5117
Practice Address - Country:US
Practice Address - Phone:719-566-1189
Practice Address - Fax:719-566-1189
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COAL-0048310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility