Provider Demographics
NPI:1902253057
Name:GENE COOK SUPPORTS, LLC
Entity Type:Organization
Organization Name:GENE COOK SUPPORTS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:EUGENE
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:COOK
Authorized Official - Suffix:SR
Authorized Official - Credentials:OWNER/ CEO
Authorized Official - Phone:724-217-5479
Mailing Address - Street 1:108 2ND AVE
Mailing Address - Street 2:
Mailing Address - City:SCOTTDALE
Mailing Address - State:PA
Mailing Address - Zip Code:15683-2105
Mailing Address - Country:US
Mailing Address - Phone:724-217-5479
Mailing Address - Fax:724-220-5194
Practice Address - Street 1:108 2ND AVE
Practice Address - Street 2:
Practice Address - City:SCOTTDALE
Practice Address - State:PA
Practice Address - Zip Code:15683-2105
Practice Address - Country:US
Practice Address - Phone:724-217-5479
Practice Address - Fax:724-220-5194
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-18
Last Update Date:2020-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA251J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA24117708OtherPA DL
PA$$$$$$$$$OtherSSN
PA1028009370001OtherMPI
PA24117708OtherPA DL