Provider Demographics
NPI:1558520841
Name:CORECARE BEHAVIORAL HEALTH MANAGEMENT, INC.
Entity Type:Organization
Organization Name:CORECARE BEHAVIORAL HEALTH MANAGEMENT, INC.
Other - Org Name:KIRKBRIDE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:MISS
Authorized Official - First Name:ROSE
Authorized Official - Middle Name:
Authorized Official - Last Name:DIOTTAVIO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-471-2358
Mailing Address - Street 1:111 N 49TH ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19139-2718
Mailing Address - Country:US
Mailing Address - Phone:215-471-2687
Mailing Address - Fax:215-471-2845
Practice Address - Street 1:111 N 49TH ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19139-2718
Practice Address - Country:US
Practice Address - Phone:215-471-2687
Practice Address - Fax:215-471-2845
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-03
Last Update Date:2020-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
No261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
No3245S0500XResidential Treatment FacilitiesSubstance Abuse Rehabilitation FacilitySubstance Abuse Treatment, Children
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1007737600002Medicaid