Provider Demographics
NPI:1164642807
Name:COOPER RESIDENTIAL SERVICES
Entity Type:Organization
Organization Name:COOPER RESIDENTIAL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ELFRIEDE
Authorized Official - Middle Name:
Authorized Official - Last Name:COOPER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:785-460-6771
Mailing Address - Street 1:PO BOX 609
Mailing Address - Street 2:
Mailing Address - City:COLBY
Mailing Address - State:KS
Mailing Address - Zip Code:67701-0609
Mailing Address - Country:US
Mailing Address - Phone:785-460-6771
Mailing Address - Fax:785-460-6772
Practice Address - Street 1:485 N COURT AVE
Practice Address - Street 2:
Practice Address - City:COLBY
Practice Address - State:KS
Practice Address - Zip Code:67701-2422
Practice Address - Country:US
Practice Address - Phone:785-460-6771
Practice Address - Fax:785-460-6772
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities