Provider Demographics
NPI:1073971297
Name:CORE AGENCY GROUP
Entity Type:Organization
Organization Name:CORE AGENCY GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:
Authorized Official - Last Name:APPLEWHITE
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:318-789-6819
Mailing Address - Street 1:122 GRIFFIN RD
Mailing Address - Street 2:
Mailing Address - City:DOWNSVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:71234-5700
Mailing Address - Country:US
Mailing Address - Phone:318-789-6819
Mailing Address - Fax:
Practice Address - Street 1:865 WILLIAMS COLONY RD
Practice Address - Street 2:
Practice Address - City:DOWNSVILLE
Practice Address - State:LA
Practice Address - Zip Code:71234-5905
Practice Address - Country:US
Practice Address - Phone:318-789-6819
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-02
Last Update Date:2016-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA322D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children