Provider Demographics
NPI:1467437475
Name:COOPERATIVE HOME CARE, INC.
Entity Type:Organization
Organization Name:COOPERATIVE HOME CARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO & OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MITCH
Authorized Official - Middle Name:I
Authorized Official - Last Name:WAKS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-772-8585
Mailing Address - Street 1:1924 MARCONI AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63110-3038
Mailing Address - Country:US
Mailing Address - Phone:314-772-8585
Mailing Address - Fax:314-772-2820
Practice Address - Street 1:1924 MARCONI AVE
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63110-3038
Practice Address - Country:US
Practice Address - Phone:314-776-2336
Practice Address - Fax:314-865-4418
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-13
Last Update Date:2019-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO775251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO267562Medicare ID - Type UnspecifiedHOME HEALTH