Provider Demographics
NPI:1588340939
Name:COS PLACE LLC
Entity type:Organization
Organization Name:COS PLACE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/EXECUTIVE DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:BENITHA
Authorized Official - Middle Name:
Authorized Official - Last Name:MASS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:256-227-0369
Mailing Address - Street 1:212 W TROY ST STE B
Mailing Address - Street 2:
Mailing Address - City:DOTHAN
Mailing Address - State:AL
Mailing Address - Zip Code:36303
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1010 5TH AVENUE SOUTHWEST
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:AL
Practice Address - Zip Code:35601
Practice Address - Country:US
Practice Address - Phone:256-227-0369
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-22
Last Update Date:2023-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health