Organization
GENE COOK SUPPORTS, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. EUGENE THOMAS COOK SR. OWNER/ CEO (OWNER/ CEO)
(724) 217-5479
Entity
Organization
Contact information
Practice address
108 2ND AVE, SCOTTDALE, PA 15683-2105
(724) 217-5479
(724) 220-5194
Mailing address
108 2ND AVE, SCOTTDALE, PA 15683-2105
(724) 217-5479
(724) 220-5194
Taxonomy
Speciality
Code
Description
License number
State
251J00000X
Nursing Care Agency
Primary
—
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
$$$$$$$$$
SSN
PA
01
—
1028009370001
MPI
PA
01
—
24117708
PA DL
PA
Enumeration date
05/18/2016
Last updated
05/21/2020
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