Provider Demographics
NPI:1194442814
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 1:120 CAPCOM AVE STE 103
Mailing Address - Street 2:
Mailing Address - City:WAKE FOREST
Mailing Address - State:NC
Mailing Address - Zip Code:27587-6537
Mailing Address - Country:US
Mailing Address - Phone:708-543-4310
Mailing Address - Fax:919-457-1492
Practice Address - Street 1:120 CAPCOM AVE STE 103
Practice Address - Street 2:
Practice Address - City:WAKE FOREST
Practice Address - State:NC
Practice Address - Zip Code:27587-6537
Practice Address - Country:US
Practice Address - Phone:708-543-4310
Practice Address - Fax:919-457-1492
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-24
Last Update Date:2022-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care