Provider Demographics
NPI:1811348600
Name:COG HOME HEALTH SERVICES LLC
Entity type:Organization
Organization Name:COG HOME HEALTH SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF HOME HEALTH SERVICES
Authorized Official - Prefix:
Authorized Official - First Name:KIM
Authorized Official - Middle Name:T
Authorized Official - Last Name:JEROME
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:340-718-2665
Mailing Address - Street 1:4500 SUNNY ISLE
Mailing Address - Street 2:SUITE 301
Mailing Address - City:CHRISTIANSTED
Mailing Address - State:VI
Mailing Address - Zip Code:00820-4493
Mailing Address - Country:US
Mailing Address - Phone:340-718-2665
Mailing Address - Fax:
Practice Address - Street 1:4500 SUNNY ISLE
Practice Address - Street 2:SUITE 301
Practice Address - City:CHRISTIANSTED
Practice Address - State:VI
Practice Address - Zip Code:00820-4493
Practice Address - Country:US
Practice Address - Phone:340-718-2665
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COMPREHENSIVE ORTHOPEDICS PLLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-06-23
Last Update Date:2016-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251E00000X
VI251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health