Provider Demographics
NPI:1801123724
Name:COPP'S RESIDENTIAL CARE INC
Entity type:Organization
Organization Name:COPP'S RESIDENTIAL CARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:TRACY
Authorized Official - Middle Name:Y
Authorized Official - Last Name:COPP
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:918-341-2543
Mailing Address - Street 1:14092 EAST 500 ROAD
Mailing Address - Street 2:
Mailing Address - City:CLAREMORE
Mailing Address - State:OK
Mailing Address - Zip Code:74019-1167
Mailing Address - Country:US
Mailing Address - Phone:918-341-2543
Mailing Address - Fax:918-342-3674
Practice Address - Street 1:14092 E 500 RD
Practice Address - Street 2:
Practice Address - City:CLAREMORE
Practice Address - State:OK
Practice Address - Zip Code:74019-1167
Practice Address - Country:US
Practice Address - Phone:918-341-2543
Practice Address - Fax:918-342-3674
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-13
Last Update Date:2009-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKRC6601310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility