Organization
CAMS COZY CORNER
Active
Organization
CAMS COZY CORNER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CARMON FREDRICK GADDIE (CEO)
(909) 204-8854
Entity
Organization
Contact information
Practice address
4 AVERY BROOK CT, MANVEL, TX 77578-1796
(909) 204-8854
Mailing address
4 AVERY BROOK CT, MANVEL, TX 77578-1796
(909) 204-8854
Taxonomy
Speciality
Code
Description
License number
State
251G00000X
Community Based Hospice Care Agency
Primary
—
—
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
—
—
320700000X
Physical Disabilities Residential Treatment Facility
—
—
320800000X
Mental Illness Community Based Residential Treatment Facility
—
—
Other
Enumeration date
06/21/2024
Last updated
06/21/2024
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