Basic Information
| Provider Information | |||||||||
| NPI: | 1437154820 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | COOPERATIVE HOME HEALTH CARE OF ATLANTIC COUNTY, INC. | ||||||||
| LastName: | |||||||||
| FirstName: | |||||||||
| MiddleName: | |||||||||
| NamePrefix: | |||||||||
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| Credential: | |||||||||
| OtherOrganizationName: | ATLANTICARE HOMECARE | ||||||||
| OtherOrganizationType: | 3 | ||||||||
| OtherLastName: | |||||||||
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| OtherMiddleName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 6550 DELILAH RD | ||||||||
| Address2: | SUITE 304 | ||||||||
| City: | EGG HARBOR TWP | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 082345142 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6094847300 | ||||||||
| FaxNumber: | 6094075384 | ||||||||
| Practice Location | |||||||||
| Address1: | 6550 DELILAH RD | ||||||||
| Address2: | SUITE 304 | ||||||||
| City: | EGG HARBOR TWP | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 082345142 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6094847300 | ||||||||
| FaxNumber: | 6094075384 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/14/2005 | ||||||||
| LastUpdateDate: | 09/10/2008 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | WOLOWNIK | ||||||||
| AuthorizedOfficialFirstName: | ELLEN | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | EXECUTIVE DIRECTOR / ADMINISTRATOR | ||||||||
| AuthorizedOfficialTelephone: | 6094847318 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | |||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | RN | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251E00000X | 22394 | NJ | Y | Agencies | Home Health |
ID Information
| ID | Type | State | Issuer | Description | 8654701 | 05 | NJ | MEDICAID |