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Organization
COZIE'S SUPERVISED LIVING INC
Active
Organization
COZIE'S SUPERVISED LIVING INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. CRYSTAL DEMETRUS SHOFFNER (EXECUTIVE DIRECTOR)
(336) 549-1081
Entity
Organization
Contact information
Practice address
7964 COUNTY LINE RD, LIBERTY, NC 27298-9590
(336) 622-2754
(336) 622-1420
Mailing address
7964 COUNTY LINE RD, LIBERTY, NC 27298-9655
(336) 622-2754
(336) 622-1420
Taxonomy
Speciality
Code
Description
License number
State
323P00000X
Psychiatric Residential Treatment Facility
Primary
MHL-001-074
NC
323P00000X
Psychiatric Residential Treatment Facility
MHL-076-098
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3409308
—
NC
05
—
7803981
—
NC
Enumeration date
04/28/2009
Last updated
09/19/2016
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