Provider Demographics
NPI:1932385945
Name:CO-OP MANAGED HEALTH CARE
Entity Type:Organization
Organization Name:CO-OP MANAGED HEALTH CARE
Other - Org Name:CO-OP CARE AGENCY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO/ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:KAY
Authorized Official - Last Name:FULLER
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:757-576-8400
Mailing Address - Street 1:205 THOROUGHBRED LN
Mailing Address - Street 2:#202
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23320-2695
Mailing Address - Country:US
Mailing Address - Phone:757-576-8400
Mailing Address - Fax:
Practice Address - Street 1:205 THOROUGHBRED LN
Practice Address - Street 2:#202
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23320-2695
Practice Address - Country:US
Practice Address - Phone:757-576-8400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-21
Last Update Date:2008-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0001210835251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health