Provider Demographics
NPI:1033509070
Name:COPE COMMUNITY SERVICES, INC.
Entity Type:Organization
Organization Name:COPE COMMUNITY SERVICES, INC.
Other - Org Name:FIFTH STREET INTEGRATED CLINIC
Other - Org Type:Other Name
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:RODNEY
Authorized Official - Middle Name:
Authorized Official - Last Name:COOK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:520-792-3293
Mailing Address - Street 1:1477 W COMMERCE CT
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85746-6016
Mailing Address - Country:US
Mailing Address - Phone:520-792-3293
Mailing Address - Fax:520-792-4336
Practice Address - Street 1:5401 E 5TH ST
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85711-2333
Practice Address - Country:US
Practice Address - Phone:520-792-3293
Practice Address - Fax:520-792-4336
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-29
Last Update Date:2021-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZOTC6987207RA0401X, 251B00000X, 251S00000X, 261QC1500X, 261QM2800X, 251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral HealthGroup - Multi-Specialty
No207RA0401XAllopathic & Osteopathic PhysiciansInternal MedicineAddiction MedicineGroup - Multi-Specialty
No251B00000XAgenciesCase ManagementGroup - Multi-Specialty
No261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health
Yes261QM2800XAmbulatory Health Care FacilitiesClinic/CenterMethadoneGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ031601Medicaid