1669665865 NPI number — COOPER HOUSE WOMEN'S RECOVERY PROGRAM

Table of content: (NPI 1669665865)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1669665865 NPI number — COOPER HOUSE WOMEN'S RECOVERY PROGRAM

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COOPER HOUSE WOMEN'S RECOVERY PROGRAM
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
THE COOPER HEALTH SYSTEM
Provider Other Organization Name Type Code:
5
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1669665865
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/21/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7250 WESTFIELD AVE
Provider Second Line Business Mailing Address:
SUITE J
Provider Business Mailing Address City Name:
PENNSAUKEN
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
08110-4093
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
856-662-0221
Provider Business Mailing Address Fax Number:
856-662-2776

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7250 WESTFIELD AVE
Provider Second Line Business Practice Location Address:
SUITE J
Provider Business Practice Location Address City Name:
PENNSAUKEN
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08110-4093
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
856-662-0221
Provider Business Practice Location Address Fax Number:
856-662-2776
Provider Enumeration Date:
08/21/2007

Additional Information

Authorized Official

Authorized Official Last Name:
PRESTON
Authorized Official First Name:
NORRIS
Authorized Official Middle Name:
Authorized Official Title or Position:
PROGRAM DIRECTOR
Authorized Official Telephone Number:
856-662-1158

Provider Taxonomy Codes

  • Taxonomy code: 282N00000X , with the licence number:  10402 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 7705701 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".




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