Healthcare Provider Details

I. General information

NPI: 1689719908
Provider Name (Legal Business Name): COOPERATIVE ELDER SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/21/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9 MERIAM ST SUITE 28
LEXINGTON MA
02420-5300
US

IV. Provider business mailing address

9 MERIAM ST SUITE 28
LEXINGTON MA
02420-5300
US

V. Phone/Fax

Practice location:
  • Phone: 781-863-2261
  • Fax: 781-863-1477
Mailing address:
  • Phone: 781-863-2261
  • Fax: 781-863-1477

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number StateMA

VIII. Authorized Official

Name: MS. JOANNA CAROL FULLER
Title or Position: EXECUTIVE DIRECTOR
Credential: MSSW
Phone: 781-863-2261