Provider Demographics
NPI:1245665157
Name:COPE BEHAVIOR HEALTH, LLC
Entity type:Organization
Organization Name:COPE BEHAVIOR HEALTH, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:MARIO
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:470-687-0700
Mailing Address - Street 1:2302 PARKLAKE DR NE STE 370
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30345-2907
Mailing Address - Country:US
Mailing Address - Phone:470-687-0700
Mailing Address - Fax:678-275-8160
Practice Address - Street 1:2302 PARKLAKE DR NE STE 370
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30345-2907
Practice Address - Country:US
Practice Address - Phone:470-687-0700
Practice Address - Fax:678-275-8160
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-10
Last Update Date:2024-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA320800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA0000000Medicaid