MEDICARE: COPE BEHAVIORAL HEALTH LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1346729126
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COPE BEHAVIORAL HEALTH LLC

Provider Business Mailing Address
First Line	:	2302 PARKLAKE DR NE STE 370
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30345-2907
Country	:	US
Telephone Number	:	470-687-0700
Fax Number	:	678-985-0188

Provider Business Practice Location Address
First Line	:	2302 PARKLAKE DR NE STE 370
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30345-2907
Country	:	US
Telephone Number	:	470-687-0700
Fax Number	:	678-985-0188

Authorized Official
Title or Position	:	CEO/OWNER
Name	:	MARIO JOHNSON
Credential	:
Telephone Number	:	470-689-0700

Provider Enumeration Date	:	08/13/2018
Last Update Date	:	02/14/2024

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