Provider Demographics
NPI:1215465158
Name:DIVINE COOPER CARE PA, LLC
Entity type:Organization
Organization Name:DIVINE COOPER CARE PA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:ARIE
Authorized Official - Middle Name:
Authorized Official - Last Name:COOPER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:610-356-5727
Mailing Address - Street 1:3539 W CHESTER PIKE
Mailing Address - Street 2:
Mailing Address - City:NEWTOWN SQUARE
Mailing Address - State:PA
Mailing Address - Zip Code:19073-3701
Mailing Address - Country:US
Mailing Address - Phone:610-356-5727
Mailing Address - Fax:610-325-4045
Practice Address - Street 1:3539 W CHESTER PIKE
Practice Address - Street 2:
Practice Address - City:NEWTOWN SQUARE
Practice Address - State:PA
Practice Address - Zip Code:19073-3701
Practice Address - Country:US
Practice Address - Phone:610-356-5727
Practice Address - Fax:610-325-4045
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-23
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care