Provider Demographics
NPI:1689719908
Name:COOPERATIVE ELDER SERVICES, INC.
Entity Type:Organization
Organization Name:COOPERATIVE ELDER SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:JOANNA
Authorized Official - Middle Name:CAROL
Authorized Official - Last Name:FULLER
Authorized Official - Suffix:
Authorized Official - Credentials:MSSW
Authorized Official - Phone:781-863-2261
Mailing Address - Street 1:9 MERIAM ST
Mailing Address - Street 2:SUITE 28
Mailing Address - City:LEXINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:02420-5300
Mailing Address - Country:US
Mailing Address - Phone:781-863-2261
Mailing Address - Fax:781-863-1477
Practice Address - Street 1:9 MERIAM ST
Practice Address - Street 2:SUITE 28
Practice Address - City:LEXINGTON
Practice Address - State:MA
Practice Address - Zip Code:02420-5300
Practice Address - Country:US
Practice Address - Phone:781-863-2261
Practice Address - Fax:781-863-1477
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA261QA0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1902628Medicaid
MA1900544Medicaid
MA1901753Medicaid
MA1905228Medicaid
MA1902148Medicaid
MA1900846Medicaid