Organization
COOSHA'E CARES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. SHANTAE COPPOCK (OWNER/ FOUNDER)
(267) 241-1161
Entity
Organization
Contact information
Practice address
501 S 63RD ST STE 1, PHILADELPHIA, PA 19143-1018
(267) 507-0545
Mailing address
501 S 63RD ST STE 1, PHILADELPHIA, PA 19143-1018
(267) 507-0545
Taxonomy
Speciality
Code
Description
License number
State
251E00000X
Home Health Agency
—
—
253Z00000X
In Home Supportive Care Agency
Primary
—
—
Other
Enumeration date
04/20/2021
Last updated
09/29/2021
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