Organization
COSMICCARE
Active
Organization
COSMICCARE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DEONTRAE JAVON SPRUILL (MANAGER/ CREATOR)
(816) 489-2299
Entity
Organization
Contact information
Practice address
1033 SHANNON ST, ELIZABETH CITY, NC 27909-6063
(816) 489-2299
Mailing address
1033 SHANNON ST, ELIZABETH CITY, NC 27909-6063
(816) 489-2299
Taxonomy
Speciality
Code
Description
License number
State
343900000X
Non-emergency Medical Transport (VAN)
—
NC
344600000X
Taxi
—
NC
347C00000X
Private Vehicle
Primary
—
—
Other
Enumeration date
11/15/2016
Last updated
11/15/2016
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