MEDICARE: ALLEN COOPER ENTERPRISE

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	385H00000X	Respite Care
2	320600000X	Intellectual and/or Developmental Disabilities Residential Treatment Facility

General Provider Information

NPI Number	:	1699507871
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ALLEN COOPER ENTERPRISE

Provider Business Mailing Address
First Line	:	1939 RED SUNSET DR
Second Line	:
City	:	DECATUR
State	:	AL
Zip	:	35603-4481
Country	:	US
Telephone Number	:	256-566-7170
Fax Number	:

Provider Business Practice Location Address
First Line	:	1508 15TH AVE SW
Second Line	:
City	:	DECATUR
State	:	AL
Zip	:	35601-5404
Country	:	US
Telephone Number	:	256-566-7170
Fax Number	:

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	MRS. ROSA ALLEN-COOPER
Credential	:
Telephone Number	:	256-566-7170

Provider Enumeration Date	:	08/16/2024
Last Update Date	:	08/16/2024

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Directions to “ALLEN COOPER ENTERPRISE ” Practice Location

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