Provider Demographics
NPI:1922830884
Name:KOSTA HEALTH PROMOTIONS LLC
Entity type:Organization
Organization Name:KOSTA HEALTH PROMOTIONS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:KOSTA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:419-355-9169
Mailing Address - Street 1:2521 COUNTY ROAD 41
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:OH
Mailing Address - Zip Code:43420-8980
Mailing Address - Country:US
Mailing Address - Phone:419-355-9169
Mailing Address - Fax:
Practice Address - Street 1:200 S ARCH ST
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:OH
Practice Address - Zip Code:43420-2961
Practice Address - Country:US
Practice Address - Phone:419-680-3000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-19
Last Update Date:2024-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty