Provider Demographics
NPI: | 1629100482 |
---|---|
Name: | NURSECORE MANAGEMENT SERVICES, LLC |
Entity Type: | Organization |
Organization Name: | NURSECORE MANAGEMENT SERVICES, LLC |
Other - Org Name: | NURSECORE OF ARLINGTON |
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: | 2517 8TH AVE STE 101 |
Practice Address - Street 2: | |
Practice Address - City: | FORT WORTH |
Practice Address - State: | TX |
Practice Address - Zip Code: | 76110-2568 |
Practice Address - Country: | US |
Practice Address - Phone: | 817-795-0567 |
Practice Address - Fax: | |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2007-03-09 |
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 | ||
No | 163WH0200X | Nursing Service Providers | Registered Nurse | Home Health | 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 | 235Z00000X | Speech, Language and Hearing Service Providers | Speech-Language Pathologist | 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 | 2937492 | Medicaid |