Provider Demographics
NPI:1366818189
Name:AZUL COSSART
Entity type:Organization
Organization Name:AZUL COSSART
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:NON MEDICAL CAREGIVER
Authorized Official - Prefix:MISS
Authorized Official - First Name:AZUL
Authorized Official - Middle Name:EZZETTE
Authorized Official - Last Name:COSSART
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-525-7691
Mailing Address - Street 1:1905 W LAS PALMARITAS DRIVE
Mailing Address - Street 2:268
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85021
Mailing Address - Country:US
Mailing Address - Phone:602-525-7691
Mailing Address - Fax:
Practice Address - Street 1:1905 W LAS PALMARITAS DR
Practice Address - Street 2:268
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85021-5000
Practice Address - Country:US
Practice Address - Phone:602-525-7691
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-16
Last Update Date:2015-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD01594471347C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes347C00000XTransportation ServicesPrivate Vehicle