Provider Demographics
NPI:1457459786
Name:NURSECORE MANAGEMENT SERVICES, LLC
Entity Type:Organization
Organization Name:NURSECORE MANAGEMENT SERVICES, LLC
Other - Org Name:NURSECORE OF COLORADO SPRINGS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:
Authorized Official - Last Name:LOLLAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-649-1166
Mailing Address - Street 1:PO BOX 201925
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76006-1925
Mailing Address - Country:US
Mailing Address - Phone:817-649-1166
Mailing Address - Fax:817-649-2638
Practice Address - Street 1:5426 N ACADEMY BLVD STE 110
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80918-3686
Practice Address - Country:US
Practice Address - Phone:719-884-1388
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2022-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251E00000XAgenciesHome HealthGroup - Multi-Specialty
No376J00000XNursing Service Related ProvidersHomemakerGroup - Multi-Specialty
No385H00000XRespite Care FacilityRespite Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO9000193556Medicaid