Provider Demographics
NPI:1447575204
Name:COOPERATIVE HOME CARE ASSOCIATES, INC
Entity Type:Organization
Organization Name:COOPERATIVE HOME CARE ASSOCIATES, INC
Other - Org Name:COOPERATIVE HOME ATTENDANT PROGRAM
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:
Authorized Official - First Name:ADRIA
Authorized Official - Middle Name:
Authorized Official - Last Name:POWELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-742-5764
Mailing Address - Street 1:400 E FORDHAM RD
Mailing Address - Street 2:13TH FLOOR
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10458-5039
Mailing Address - Country:US
Mailing Address - Phone:718-993-7104
Mailing Address - Fax:718-993-0971
Practice Address - Street 1:400 E FORDHAM RD
Practice Address - Street 2:13TH FLOOR
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10458-5039
Practice Address - Country:US
Practice Address - Phone:718-993-7104
Practice Address - Fax:718-993-0971
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-05
Last Update Date:2018-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0283L001251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02936327Medicaid
NY02960456Medicaid