Provider Demographics
NPI:1477950723
Name:HEALTHCORE RESOURCE INC
Entity Type:Organization
Organization Name:HEALTHCORE RESOURCE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPERATIONS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:FASHENDA
Authorized Official - Middle Name:
Authorized Official - Last Name:LITTLE-GERALD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-577-2139
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:704-577-2139
Mailing Address - Fax:919-872-1170
Practice Address - Street 1:716 E FAIRFIELD RD
Practice Address - Street 2:SUITE 102
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29605-3609
Practice Address - Country:US
Practice Address - Phone:704-577-2139
Practice Address - Fax:919-872-1170
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-02
Last Update Date:2014-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8301768HMedicaid