Provider Demographics
NPI:1669665865
Name:COOPER HOUSE WOMEN'S RECOVERY PROGRAM
Entity Type:Organization
Organization Name:COOPER HOUSE WOMEN'S RECOVERY PROGRAM
Other - Org Name:THE COOPER HEALTH SYSTEM
Other - Org Type:Other Name
Authorized Official - Title/Position:PROGRAM DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:NORRIS
Authorized Official - Middle Name:
Authorized Official - Last Name:PRESTON
Authorized Official - Suffix:
Authorized Official - Credentials:MHS, MSW
Authorized Official - Phone:856-662-1158
Mailing Address - Street 1:7250 WESTFIELD AVE
Mailing Address - Street 2:SUITE J
Mailing Address - City:PENNSAUKEN
Mailing Address - State:NJ
Mailing Address - Zip Code:08110-4093
Mailing Address - Country:US
Mailing Address - Phone:856-662-0221
Mailing Address - Fax:856-662-2776
Practice Address - Street 1:7250 WESTFIELD AVE
Practice Address - Street 2:SUITE J
Practice Address - City:PENNSAUKEN
Practice Address - State:NJ
Practice Address - Zip Code:08110-4093
Practice Address - Country:US
Practice Address - Phone:856-662-0221
Practice Address - Fax:856-662-2776
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:THE COOPER HEALTH SYSTEM
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-08-21
Last Update Date:2007-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ10402282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ7705701Medicaid