Provider Demographics
NPI:1265651293
Name:HEALTHCORE HOME CARE
Entity Type:Organization
Organization Name:HEALTHCORE HOME CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:IJEOMA
Authorized Official - Middle Name:E
Authorized Official - Last Name:NWAEZE
Authorized Official - Suffix:
Authorized Official - Credentials:RN, NP, MSN
Authorized Official - Phone:919-872-1178
Mailing Address - Street 1:1001 NAVAHO DR
Mailing Address - Street 2:SUITE 101
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27609-7335
Mailing Address - Country:US
Mailing Address - Phone:919-872-1178
Mailing Address - Fax:919-872-1170
Practice Address - Street 1:1001 NAVAHO DR
Practice Address - Street 2:SUITE 101
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27609-7335
Practice Address - Country:US
Practice Address - Phone:919-872-1178
Practice Address - Fax:919-872-1170
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-25
Last Update Date:2015-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251E00000X
NCHC2378251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC3409613Medicaid