Provider Demographics
NPI:1003109471
Name:FAMILY HEALTH & WELLNESS OPPORTUNITY CENTER
Entity Type:Organization
Organization Name:FAMILY HEALTH & WELLNESS OPPORTUNITY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JESSE
Authorized Official - Middle Name:M
Authorized Official - Last Name:COOPER
Authorized Official - Suffix:SR
Authorized Official - Credentials:PHD
Authorized Official - Phone:856-858-5850
Mailing Address - Street 1:900 HADDON AVE
Mailing Address - Street 2:SUITE 233
Mailing Address - City:COLLINGSWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:08108-2101
Mailing Address - Country:US
Mailing Address - Phone:856-858-5850
Mailing Address - Fax:858-858-5833
Practice Address - Street 1:336 STAUNTON CT
Practice Address - Street 2:
Practice Address - City:WILLIAMSTOWN
Practice Address - State:NJ
Practice Address - Zip Code:08094-8803
Practice Address - Country:US
Practice Address - Phone:856-858-5850
Practice Address - Fax:856-858-5833
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-18
Last Update Date:2011-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ2000505-11261QR0405X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder