# COZIE'S SUPERVISED LIVING INC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1770727281
- **Authorized official:** MS. CRYSTAL DEMETRUS SHOFFNER (EXECUTIVE DIRECTOR)
- **Authorized official phone:** (336) 549-1081

## Contact information

- **Practice address:** 7964 COUNTY LINE RD, LIBERTY, NC 27298-9590
- **Practice address phone:** (336) 622-2754
- **Practice address fax:** (336) 622-1420
- **Mailing address:** 7964 COUNTY LINE RD, LIBERTY, NC 27298-9655
- **Mailing address phone:** (336) 622-2754
- **Mailing address fax:** (336) 622-1420

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 323P00000X | Psychiatric Residential Treatment Facility | MHL-001-074 | NC | Yes |
| 323P00000X | Psychiatric Residential Treatment Facility | MHL-076-098 | NC | — |

## Other

- **Enumeration date:** 04/28/2009
- **Last updated:** 09/19/2016

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 3409308 | — | NC |
| 05 | — | 7803981 | — | NC |