Provider Demographics
NPI:1831643816
Name:PAUL J. COOPER CENTER FOR HUMAN SERVICES, INC.
Entity Type:Organization
Organization Name:PAUL J. COOPER CENTER FOR HUMAN SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:PETER
Authorized Official - Middle Name:
Authorized Official - Last Name:CAMPBELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-498-5555
Mailing Address - Street 1:510 GATES AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11216-1506
Mailing Address - Country:US
Mailing Address - Phone:718-498-5555
Mailing Address - Fax:718-498-6868
Practice Address - Street 1:510 GATES AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11216-1506
Practice Address - Country:US
Practice Address - Phone:718-498-5555
Practice Address - Fax:718-498-6868
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-08
Last Update Date:2016-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY161010577261QR0405X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00244931Medicaid
NYWX0421Medicare Oscar/Certification