Provider Demographics
NPI:1720419666
Name:COOPER OPERATING LLC
Entity Type:Organization
Organization Name:COOPER OPERATING LLC
Other - Org Name:MAJESTIC CENTER FOR REHAB & SUB- ACUTE CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:CHARLES-EDOUARD
Authorized Official - Middle Name:
Authorized Official - Last Name:GROS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-360-8083
Mailing Address - Street 1:2 COOPER PLZ
Mailing Address - Street 2:
Mailing Address - City:CAMDEN
Mailing Address - State:NJ
Mailing Address - Zip Code:08103-1461
Mailing Address - Country:US
Mailing Address - Phone:856-342-7600
Mailing Address - Fax:718-732-2481
Practice Address - Street 1:2 COOPER PLZ
Practice Address - Street 2:
Practice Address - City:CAMDEN
Practice Address - State:NJ
Practice Address - Zip Code:08103-1461
Practice Address - Country:US
Practice Address - Phone:856-342-7600
Practice Address - Fax:718-732-2481
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COOPER VENTURES LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-12-03
Last Update Date:2016-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ060412314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ4470303Medicaid
NJ4470303Medicaid