Provider Demographics
NPI:1528642931
Name:COZ FATE HOME HEALTH AGENCY
Entity type:Organization
Organization Name:COZ FATE HOME HEALTH AGENCY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:QUOTERRIS
Authorized Official - Middle Name:
Authorized Official - Last Name:GRAY
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:832-271-0911
Mailing Address - Street 1:5411 AUTUMN LEAF CT
Mailing Address - Street 2:
Mailing Address - City:ROSHARON
Mailing Address - State:TX
Mailing Address - Zip Code:77583-2530
Mailing Address - Country:US
Mailing Address - Phone:832-271-0911
Mailing Address - Fax:
Practice Address - Street 1:5411 AUTUMN LEAF CT
Practice Address - Street 2:
Practice Address - City:ROSHARON
Practice Address - State:TX
Practice Address - Zip Code:77583-2530
Practice Address - Country:US
Practice Address - Phone:832-271-0911
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-11
Last Update Date:2021-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health