Provider Demographics
NPI:1598124828
Name:COOPERATIVE CARE PARTNERSHIP, INC.
Entity Type:Organization
Organization Name:COOPERATIVE CARE PARTNERSHIP, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MS
Authorized Official - First Name:SHANNA
Authorized Official - Middle Name:D
Authorized Official - Last Name:LEARN
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:609-741-6363
Mailing Address - Street 1:1076 ROUTE 47 S
Mailing Address - Street 2:
Mailing Address - City:RIO GRANDE
Mailing Address - State:NJ
Mailing Address - Zip Code:08242-1608
Mailing Address - Country:US
Mailing Address - Phone:609-741-6363
Mailing Address - Fax:609-435-5058
Practice Address - Street 1:1076 ROUTE 47 S
Practice Address - Street 2:
Practice Address - City:RIO GRANDE
Practice Address - State:NJ
Practice Address - Zip Code:08242-1608
Practice Address - Country:US
Practice Address - Phone:609-741-6363
Practice Address - Fax:609-435-5058
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-15
Last Update Date:2016-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ2000559251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0433489Medicaid