Provider Demographics
NPI:1881825735
Name:COOPER, CHRISTINE BAILEY (PROGRAM DIRECTOR)
Entity Type:Individual
Prefix:MRS
First Name:CHRISTINE
Middle Name:BAILEY
Last Name:COOPER
Suffix:
Gender:F
Credentials:PROGRAM DIRECTOR
Other - Prefix:MR
Other - First Name:TRAVIS
Other - Middle Name:RON
Other - Last Name:HOWARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CEO
Mailing Address - Street 1:100 SOUTH MAIN ST
Mailing Address - Street 2:
Mailing Address - City:LITTLETON
Mailing Address - State:NC
Mailing Address - Zip Code:27850-1143
Mailing Address - Country:US
Mailing Address - Phone:252-586-0100
Mailing Address - Fax:252-586-0121
Practice Address - Street 1:100 SOUTH MAIN ST
Practice Address - Street 2:
Practice Address - City:LITTLETON
Practice Address - State:NC
Practice Address - Zip Code:27850-1143
Practice Address - Country:US
Practice Address - Phone:252-586-0100
Practice Address - Fax:252-586-0121
Is Sole Proprietor?:No
Enumeration Date:2009-07-27
Last Update Date:2022-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCHC3849374U00000X, 376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
No376K00000XNursing Service Related ProvidersNurse's Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC26-4232877Medicaid