Provider Demographics
NPI:1679606883
Name:COOPERRIIS INC
Entity Type:Organization
Organization Name:COOPERRIIS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:A
Authorized Official - Last Name:LEVINE
Authorized Official - Suffix:
Authorized Official - Credentials:EDD
Authorized Official - Phone:828-894-7310
Mailing Address - Street 1:101 HEALING FARM LANE
Mailing Address - Street 2:
Mailing Address - City:MILL SPRING
Mailing Address - State:NC
Mailing Address - Zip Code:28756
Mailing Address - Country:US
Mailing Address - Phone:828-894-5557
Mailing Address - Fax:844-965-9530
Practice Address - Street 1:101 HEALING FARM LANE
Practice Address - Street 2:
Practice Address - City:MILL SPRING
Practice Address - State:NC
Practice Address - Zip Code:28756
Practice Address - Country:US
Practice Address - Phone:828-894-7122
Practice Address - Fax:828-894-7111
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-14
Last Update Date:2020-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes323P00000XResidential Treatment FacilitiesPsychiatric Residential Treatment Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6005719Medicaid
NC6005719Medicaid