Provider Demographics
NPI:1023583663
Name:COPE PERSONAL DEVELOPMENT CENTER
Entity type:Organization
Organization Name:COPE PERSONAL DEVELOPMENT CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TINA
Authorized Official - Middle Name:LARAYNE
Authorized Official - Last Name:PARKMAN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:248-991-5779
Mailing Address - Street 1:26711 WOODWARD AVE STE LL3
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON WOODS
Mailing Address - State:MI
Mailing Address - Zip Code:48070-1370
Mailing Address - Country:US
Mailing Address - Phone:844-948-1661
Mailing Address - Fax:888-318-6010
Practice Address - Street 1:26711 WOODWARD AVE STE LL2
Practice Address - Street 2:
Practice Address - City:HUNTINGTON WOODS
Practice Address - State:MI
Practice Address - Zip Code:48070-1370
Practice Address - Country:US
Practice Address - Phone:844-948-1661
Practice Address - Fax:888-318-6010
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COPE PERSONAL DEVELOPMENT CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-10-10
Last Update Date:2018-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WA0400XNursing Service ProvidersRegistered NurseAddiction (Substance Use Disorder)Group - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No163WC0400XNursing Service ProvidersRegistered NurseCase ManagementGroup - Multi-Specialty
No171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Multi-Specialty
No251E00000XAgenciesHome HealthGroup - Multi-Specialty
No251S00000XAgenciesCommunity/Behavioral Health
No261QE0002XAmbulatory Health Care FacilitiesClinic/CenterEmergency CareGroup - Multi-Specialty