Provider Demographics
NPI:1184447260
Name:MITA COOKE HEALTH SERVICES INC
Entity type:Organization
Organization Name:MITA COOKE HEALTH SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:BOSUN
Authorized Official - Middle Name:
Authorized Official - Last Name:OLOKO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-768-9607
Mailing Address - Street 1:1709 REBECCA CT
Mailing Address - Street 2:
Mailing Address - City:UPPER MARLBORO
Mailing Address - State:MD
Mailing Address - Zip Code:20774-5621
Mailing Address - Country:US
Mailing Address - Phone:301-768-9607
Mailing Address - Fax:
Practice Address - Street 1:1709 REBECCA CT
Practice Address - Street 2:
Practice Address - City:UPPER MARLBORO
Practice Address - State:MD
Practice Address - Zip Code:20774-5621
Practice Address - Country:US
Practice Address - Phone:301-768-9607
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-11-06
Last Update Date:2024-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities