MEDICARE: COPE BEHAVIOR 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	320800000X	Mental Illness Community Based Residential Treatment Facility		LA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1245665157
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COPE BEHAVIOR 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	:	678-275-8160

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	:	678-275-8160

Authorized Official
Title or Position	:	OWNER
Name	:	MR. MARIO JOHNSON
Credential	:
Telephone Number	:	470-687-0700

Provider Enumeration Date	:	09/10/2013
Last Update Date	:	02/14/2024

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