Provider Demographics
NPI:1487092250
Name:COGNITIVE & PHYSICAL HOME CARE SERVICES, LLC
Entity type:Organization
Organization Name:COGNITIVE & PHYSICAL HOME CARE SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RODERICA
Authorized Official - Middle Name:
Authorized Official - Last Name:JAMES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:313-801-3467
Mailing Address - Street 1:24333 SOUTHFIELD RD
Mailing Address - Street 2:STE. 108
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48075-2822
Mailing Address - Country:US
Mailing Address - Phone:313-595-1496
Mailing Address - Fax:313-638-1827
Practice Address - Street 1:24333 SOUTHFIELD RD
Practice Address - Street 2:STE. 108
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48075-2822
Practice Address - Country:US
Practice Address - Phone:313-595-1496
Practice Address - Fax:313-638-1827
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-13
Last Update Date:2013-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health