Provider Demographics
NPI:1467248617
Name:ICHEKWAI, COSLEY
Entity type:Individual
Prefix:
First Name:COSLEY
Middle Name:
Last Name:ICHEKWAI
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7125 KYLE AVE N
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN CENTER
Mailing Address - State:MN
Mailing Address - Zip Code:55429-1327
Mailing Address - Country:US
Mailing Address - Phone:612-458-0986
Mailing Address - Fax:
Practice Address - Street 1:7125 KYLE AVE N
Practice Address - Street 2:
Practice Address - City:BROOKLYN CENTER
Practice Address - State:MN
Practice Address - Zip Code:55429-1327
Practice Address - Country:US
Practice Address - Phone:612-458-0986
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-15
Last Update Date:2025-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility