Provider Demographics
NPI:1679606883
Name:COOPERRIIS CRA
Entity type:Organization
Organization Name:COOPERRIIS CRA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:
Authorized Official - Last Name:LEVINE
Authorized Official - Suffix:
Authorized Official - Credentials:EDD
Authorized Official - Phone:828-894-5557
Mailing Address - Street 1:101 HEALING FARM LANE
Mailing Address - Street 2:
Mailing Address - City:MILL SPRING
Mailing Address - State:NC
Mailing Address - Zip Code:28756
Mailing Address - Country:US
Mailing Address - Phone:828-894-5557
Mailing Address - Fax:844-965-9530
Practice Address - Street 1:85 ZILLICOA ST
Practice Address - Street 2:
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28801-1038
Practice Address - Country:US
Practice Address - Phone:828-771-9001
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COOPERRIIS, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-03-14
Last Update Date:2025-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes323P00000XResidential Treatment FacilitiesPsychiatric Residential Treatment Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6005719Medicaid
NC6005719Medicaid