Provider Demographics
NPI:1548204886
Name:NURSECORE MANAGEMENT SERVICES, LLC
Entity Type:Organization
Organization Name:NURSECORE MANAGEMENT SERVICES, LLC
Other - Org Name:NURSECORE OF LAS VEGAS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT / CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:Y
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 1:4423 W FLAMINGO RD
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89103-3703
Practice Address - Country:US
Practice Address - Phone:702-458-1137
Practice Address - Fax:702-458-1423
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-16
Last Update Date:2022-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV580HHA251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV2902029Medicaid
NV3002129OtherMEDICAID - WAIVER
NV3002129OtherMEDICAID - WAIVER
NV297056Medicare Oscar/Certification