Provider Demographics
NPI:1306662812
Name:COOPWOOD, SHAURICE
Entity type:Individual
Prefix:
First Name:SHAURICE
Middle Name:
Last Name:COOPWOOD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7532 S INDIANA AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60619-1614
Mailing Address - Country:US
Mailing Address - Phone:224-486-5225
Mailing Address - Fax:
Practice Address - Street 1:7532 S INDIANA AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60619-1614
Practice Address - Country:US
Practice Address - Phone:224-486-5225
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-29
Last Update Date:2024-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide