Basic Information
| Provider Information | |||||||||
| NPI: | 1013368539 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | COG HOME HEALTH SERVICES LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 9151 ESTATE THOMAS | ||||||||
| Address2: | FOOTHILLS PROFESSIONAL BUILDING SUITE 206 | ||||||||
| City: | ST. THOMAS | ||||||||
| State: | VI | ||||||||
| PostalCode: | 008024567 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3407794663 | ||||||||
| FaxNumber: | 3407792443 | ||||||||
| Practice Location | |||||||||
| Address1: | 9151 ESTATE THOMAS | ||||||||
| Address2: | FOOTHILLS PROFESSIONAL BUILDING SUITE 206 | ||||||||
| City: | ST. THOMAS | ||||||||
| State: | VI | ||||||||
| PostalCode: | 008024567 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3407792663 | ||||||||
| FaxNumber: | 3407792443 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/27/2016 | ||||||||
| LastUpdateDate: | 11/28/2016 | ||||||||
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| AuthorizedOfficialLastName: | JEROME | ||||||||
| AuthorizedOfficialFirstName: | KIM | ||||||||
| AuthorizedOfficialMiddleName: | T | ||||||||
| AuthorizedOfficialTitleorPosition: | DIRECTOR OF HOME HEALTH SERVICES | ||||||||
| AuthorizedOfficialTelephone: | 3407792663 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | COMPREHENSIVE ORTHOPEDICS PLLC | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251E00000X | Y | Agencies | Home Health |
No ID Information.