Provider Demographics
NPI:1104379304
Name:CORE TRAINING SERVICES LLC
Entity Type:Organization
Organization Name:CORE TRAINING SERVICES LLC
Other - Org Name:GROW THE VINE SPEECH & WELLNESS GYM
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/CHIEF SLP
Authorized Official - Prefix:
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:L
Authorized Official - Last Name:BARRIENTES
Authorized Official - Suffix:
Authorized Official - Credentials:MS, CCC-SLP
Authorized Official - Phone:863-712-6030
Mailing Address - Street 1:4664 E COUNTY ROAD 540A
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33813-4472
Mailing Address - Country:US
Mailing Address - Phone:863-940-9863
Mailing Address - Fax:863-583-4401
Practice Address - Street 1:527 POPPELL DR
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33813-1139
Practice Address - Country:US
Practice Address - Phone:863-712-6030
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-25
Last Update Date:2020-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL887352600Medicaid
FL102011900Medicaid