Provider Demographics
NPI:1255019618
Name:INNER COSMOS PERINATAL SERVICES LLC
Entity type:Organization
Organization Name:INNER COSMOS PERINATAL SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EMPLOYEE
Authorized Official - Prefix:
Authorized Official - First Name:CHANELLE
Authorized Official - Middle Name:RENEE
Authorized Official - Last Name:PEGUERO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:401-390-4948
Mailing Address - Street 1:69 FOUNTAIN ST
Mailing Address - Street 2:
Mailing Address - City:PAWTUCKET
Mailing Address - State:RI
Mailing Address - Zip Code:02860-1242
Mailing Address - Country:US
Mailing Address - Phone:401-584-0167
Mailing Address - Fax:
Practice Address - Street 1:69 FOUNTAIN ST
Practice Address - Street 2:
Practice Address - City:PAWTUCKET
Practice Address - State:RI
Practice Address - Zip Code:02860-1242
Practice Address - Country:US
Practice Address - Phone:401-584-0167
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-06
Last Update Date:2023-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374J00000XNursing Service Related ProvidersDoulaGroup - Single Specialty