Provider Demographics
NPI:1619551215
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:
Practice Address - Street 1:107 LANAGHAN DR
Practice Address - Street 2:
Practice Address - City:FAIRVIEW HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:62208-2730
Practice Address - Country:US
Practice Address - Phone:618-394-5681
Practice Address - Fax:314-735-4177
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-10
Last Update Date:2021-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care