Provider Demographics
NPI:1831924893
Name:COTHRAN INNOVATIONS LLC
Entity type:Organization
Organization Name:COTHRAN INNOVATIONS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ AGENCY DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SHAWN
Authorized Official - Middle Name:MICHEAL
Authorized Official - Last Name:COTHRAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:708-543-4310
Mailing Address - Street 1:9437 NIGHT HARBOR DR
Mailing Address - Street 2:
Mailing Address - City:LELAND
Mailing Address - State:NC
Mailing Address - Zip Code:28451-9596
Mailing Address - Country:US
Mailing Address - Phone:919-213-0733
Mailing Address - Fax:
Practice Address - Street 1:9437 NIGHT HARBOR DR
Practice Address - Street 2:
Practice Address - City:LELAND
Practice Address - State:NC
Practice Address - Zip Code:28451-9596
Practice Address - Country:US
Practice Address - Phone:919-213-0733
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COTHRAN INNOVATIONS LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-09-07
Last Update Date:2024-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care