Provider Demographics
NPI:1275937815
Name:COGNILIVE LLC
Entity Type:Organization
Organization Name:COGNILIVE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:HEATHER
Authorized Official - Middle Name:A
Authorized Official - Last Name:FUTCH
Authorized Official - Suffix:
Authorized Official - Credentials:BS CMC
Authorized Official - Phone:941-779-3574
Mailing Address - Street 1:PO BOX 110087
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34211
Mailing Address - Country:US
Mailing Address - Phone:941-779-3574
Mailing Address - Fax:
Practice Address - Street 1:29425 SADDLEBAG TRL
Practice Address - Street 2:
Practice Address - City:MYAKKA CITY
Practice Address - State:FL
Practice Address - Zip Code:34251-8412
Practice Address - Country:US
Practice Address - Phone:941-779-3574
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-10
Last Update Date:2014-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care