Provider Demographics
NPI: | 1558668541 |
---|---|
Name: | NURSECORE MANAGEMENT SERVICES, LLC |
Entity Type: | Organization |
Organization Name: | NURSECORE MANAGEMENT SERVICES, LLC |
Other - Org Name: | NURSECORE OF AMARILLO |
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: | 2201 BROOKHOLLOW PLAZA DR #450 |
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: | 817-649-5532 |
Practice Address - Street 1: | 4 MEDICAL DR STE C |
Practice Address - Street 2: | |
Practice Address - City: | AMARILLO |
Practice Address - State: | TX |
Practice Address - Zip Code: | 79106-4166 |
Practice Address - Country: | US |
Practice Address - Phone: | 806-358-7300 |
Practice Address - Fax: | 806-358-7301 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2011-02-28 |
Last Update Date: | 2023-03-24 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 251E00000X | Agencies | Home Health | Group - Multi-Specialty | |
No | 163WH0200X | Nursing Service Providers | Registered Nurse | Home Health | Group - Multi-Specialty |
No | 164X00000X | Nursing Service Providers | Licensed Vocational Nurse | Group - Multi-Specialty | |
No | 224Z00000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapy Assistant | Group - Multi-Specialty | |
No | 225100000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | Group - Multi-Specialty | |
No | 225200000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapy Assistant | Group - Multi-Specialty | |
No | 225X00000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | Group - Multi-Specialty | |
No | 251J00000X | Agencies | Nursing Care | Group - Multi-Specialty | |
No | 253Z00000X | Agencies | In Home Supportive Care | Group - Multi-Specialty | |
No | 372500000X | Nursing Service Related Providers | Chore Provider | Group - Multi-Specialty | |
No | 372600000X | Nursing Service Related Providers | Adult Companion | Group - Multi-Specialty | |
No | 374U00000X | Nursing Service Related Providers | Home Health Aide | Group - Multi-Specialty | |
No | 376J00000X | Nursing Service Related Providers | Homemaker | Group - Multi-Specialty | |
No | 376K00000X | Nursing Service Related Providers | Nurse's Aide | Group - Multi-Specialty | |
No | 385H00000X | Respite Care Facility | Respite Care |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
TX | 014315 | Other | HOME HEALTH LICENSE |
TX | 3065591 | Medicaid |