Cozie'S Supervised Living Inc
Organization Active NPI Psychiatric Residential Treatment Facility · Liberty, NC
NPI 1770727281 · NPPES record last updated Sep 19, 2016
Key facts
- NPI
- 1770727281
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Psychiatric Residential Treatment Facility 323P00000X
- License
- MHL-001-074 (NC)
- Legal business name
- COZIE'S SUPERVISED LIVING INC
- Practice address
- 7964 County Line Rd
Liberty, NC 27298-9590 - Phone
- (336) 622-2754
- Fax
- (336) 622-1420
- NPI assigned
- Apr 28, 2009
- Organization subpart
- No
Authorized official
- Name
- Ms. Crystal Demetrus Shoffner
- Title
- Executive Director
- Phone
- (336) 549-1081
Corporate family (same tax ID) 1
Practitioners 1
-
Francis Kwasi Ndinya, MS., CRC., LCMHC.
National Provider Directory
- Tax ID family
- Cozie'S Supervised Living Inc
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychiatric Residential Treatment Facility | 323P00000X | MHL-001-074 | NC | Yes |
| Psychiatric Residential Treatment Facility | 323P00000X | MHL-076-098 | NC |
Addresses
Primary practice location
7964 County Line Rd
Liberty, NC 27298-9590
Mailing address
7964 County Line Rd
Liberty, NC 27298-9655
Phone (336) 622-2754
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 3409308 | Medicaid | NC | |
| 7803981 | Medicaid | NC |
Other providers in Liberty, NC
- Carol Lee Family Care Home
- Cawh Rehabilitation Services, LLC.
- Janice Lanette Christenbury
- Community Innovations Inc
- Nathan W Conroy
- Cozie'S Supervised Living Inc.
- Ashley Brooke Crutchfield
- Curanex LLC
- Kaylee Renee Dillon
- Dr Thomas Blake Inc
All providers in Liberty, NC · Psychiatric Residential Treatment Facility in North Carolina
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 19, 2016. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.