Organization
COZIE'S SUPERVISED LIVING INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. CRYSTAL DUDLEY (ADMINISTRATOR)
(336) 549-1081
Entity
Organization
Contact information
Practice address
7964 COUNTY LINE RD, LIBERTY, NC 27298-9590
(336) 549-1081
(336) 622-1420
Mailing address
7964 COUNTY LINE RD, LIBERTY, NC 27298-9590
(336) 549-1081
(336) 622-1420
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
MHL-001-074
NC
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
MHL-001-074
NC
320800000X
Mental Illness Community Based Residential Treatment Facility
MHL-001-074
NC
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
MHL-001-074
NC
385H00000X
Respite Care
MHL-001-074
NC
385HR2060X
Child Intellectual and/or Developmental Disabilities Respite Care
MHL-001-074
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3409308
—
NC
05
—
7803981
—
NC
05
—
8301579
—
NC
Enumeration date
02/15/2007
Last updated
06/16/2008
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