Basic Information
| Provider Information | |||||||||
| NPI: | 1023583663 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | COPE PERSONAL DEVELOPMENT CENTER | ||||||||
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| Mailing Information | |||||||||
| Address1: | 26711 WOODWARD AVE STE LL3 | ||||||||
| Address2: | |||||||||
| City: | HUNTINGTON WOODS | ||||||||
| State: | MI | ||||||||
| PostalCode: | 480701370 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8449481661 | ||||||||
| FaxNumber: | 8883186010 | ||||||||
| Practice Location | |||||||||
| Address1: | 26711 WOODWARD AVE STE LL2 | ||||||||
| Address2: | |||||||||
| City: | HUNTINGTON WOODS | ||||||||
| State: | MI | ||||||||
| PostalCode: | 480701370 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8449481661 | ||||||||
| FaxNumber: | 8883186010 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/10/2018 | ||||||||
| LastUpdateDate: | 10/10/2018 | ||||||||
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| AuthorizedOfficialLastName: | PARKMAN | ||||||||
| AuthorizedOfficialFirstName: | TINA | ||||||||
| AuthorizedOfficialMiddleName: | LARAYNE | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 2489915779 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | COPE PERSONAL DEVELOPMENT CENTER | ||||||||
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| AuthorizedOfficialCredential: | PH.D | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YA0400X | N | 193200000X MULTI-SPECIALTY GROUP | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) | 163WC0400X | N | 193200000X MULTI-SPECIALTY GROUP | Nursing Service Providers | Registered Nurse | Case Management | 171M00000X | N | 193200000X MULTI-SPECIALTY GROUP | Other Service Providers | Case Manager/Care Coordinator | 251E00000X | N | Agencies | Home Health | 251S00000X | N | Agencies | Community/Behavioral Health | 261QE0002X | N | Ambulatory Health Care Facilities | Clinic/Center | Emergency Care | 163WA0400X | Y | 193200000X MULTI-SPECIALTY GROUP | Nursing Service Providers | Registered Nurse | Addiction (Substance Use Disorder) |
No ID Information.