Provider Demographics
NPI:1376086876
Name:CO-OPERATIVE CARE
Entity Type:Organization
Organization Name:CO-OPERATIVE CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CARL
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:SAMUELS
Authorized Official - Suffix:
Authorized Official - Credentials:CSAC
Authorized Official - Phone:336-303-9020
Mailing Address - Street 1:4310 ALDERNY PL
Mailing Address - Street 2:
Mailing Address - City:HIGH POINT
Mailing Address - State:NC
Mailing Address - Zip Code:27265-9277
Mailing Address - Country:US
Mailing Address - Phone:336-303-9020
Mailing Address - Fax:
Practice Address - Street 1:4310 ALDERNY PL
Practice Address - Street 2:
Practice Address - City:HIGH POINT
Practice Address - State:NC
Practice Address - Zip Code:27265-9277
Practice Address - Country:US
Practice Address - Phone:336-303-9020
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-01
Last Update Date:2016-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities