Provider Demographics
NPI:1205434586
Name:COLE, RICKY LEE II
Entity type:Individual
Prefix:
First Name:RICKY
Middle Name:LEE
Last Name:COLE
Suffix:II
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:63 COUNTRY SQUIRE VLG
Mailing Address - Street 2:
Mailing Address - City:MORGANTOWN
Mailing Address - State:WV
Mailing Address - Zip Code:26508-8695
Mailing Address - Country:US
Mailing Address - Phone:304-612-3750
Mailing Address - Fax:
Practice Address - Street 1:63 COUNTRY SQUIRE VLG
Practice Address - Street 2:
Practice Address - City:MORGANTOWN
Practice Address - State:WV
Practice Address - Zip Code:26508-8695
Practice Address - Country:US
Practice Address - Phone:304-612-3750
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-09
Last Update Date:2020-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant