Healthcare Provider Details

I. General information

NPI: 1184623845
Provider Name (Legal Business Name): TWO COOPER PLAZA OPERATING COMPANY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/15/2005
Last Update Date: 04/08/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 COOPER PLZ
CAMDEN NJ
08103-1461
US

IV. Provider business mailing address

2 COOPER PLZ
CAMDEN NJ
08103-1461
US

V. Phone/Fax

Practice location:
  • Phone: 856-342-7600
  • Fax: 856-342-6662
Mailing address:
  • Phone: 856-342-7600
  • Fax: 856-342-6662

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number0049140
License Number StateNJ

VIII. Authorized Official

Name: KEVIN P BRESLIN
Title or Position: EXECUTIVE VP
Credential:
Phone: 201-242-4004