Healthcare Provider Details

I. General information

NPI: 1255583860
Provider Name (Legal Business Name): COOPERATING COMMUNITY PROGRAMS, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/14/2008
Last Update Date: 10/14/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

475 CLEVELAND AVE N SUITE 101
SAINT PAUL MN
55104-5031
US

IV. Provider business mailing address

475 CLEVELAND AVE N SUITE 101
SAINT PAUL MN
55104-5031
US

V. Phone/Fax

Practice location:
  • Phone: 651-646-2400
  • Fax: 651-646-8024
Mailing address:
  • Phone: 651-646-2400
  • Fax: 651-646-8024

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code253J00000X
TaxonomyFoster Care Agency
License Number
License Number State

VIII. Authorized Official

Name: MS. APRIL BAUER
Title or Position: FINANCE ADMINISTRATOR
Credential:
Phone: 651-646-2400