Provider Demographics
NPI:1679701684
Name:PROVIDER OF CO-OP SERVICES
Entity Type:Organization
Organization Name:PROVIDER OF CO-OP SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CATHRYN
Authorized Official - Middle Name:LAURIE
Authorized Official - Last Name:STEIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:610-453-5005
Mailing Address - Street 1:1467 HARK A WAY RD
Mailing Address - Street 2:
Mailing Address - City:CHESTER SPRINGS
Mailing Address - State:PA
Mailing Address - Zip Code:19425-2302
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1467 HARK A WAY RD
Practice Address - Street 2:
Practice Address - City:CHESTER SPRINGS
Practice Address - State:PA
Practice Address - Zip Code:19425-2302
Practice Address - Country:US
Practice Address - Phone:610-453-5005
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-29
Last Update Date:2016-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN517919L163W00000X
PA102276610251C00000X, 251K00000X, 251S00000X, 302F00000X
PA385H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes302F00000XManaged Care OrganizationsExclusive Provider OrganizationGroup - Multi-Specialty
No163W00000XNursing Service ProvidersRegistered NurseGroup - Multi-Specialty
No251C00000XAgenciesDay Training, Developmentally Disabled Services
No251K00000XAgenciesPublic Health or Welfare
No251S00000XAgenciesCommunity/Behavioral Health
No385H00000XRespite Care FacilityRespite Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA102276610OtherCONSOLIDATED, BASE AND PERSON/FAMILY WAIVER
PA102276610Medicaid
PA102276610OtherMEDICAL ASSISTANCE
102276610OtherOBRA, COMMCARE AND INDEPENDANCE WAIVER
PA102276610OtherADULT AUTISM WAIVER