Provider Demographics
NPI:1750865804
Name:C O R E MEDICAL CLINIC INC
Entity Type:Organization
Organization Name:C O R E MEDICAL CLINIC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS SERVICES DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MARSHALL
Authorized Official - Middle Name:
Authorized Official - Last Name:STENSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:916-442-4985
Mailing Address - Street 1:2100 CAPITOL AVE
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95816-5721
Mailing Address - Country:US
Mailing Address - Phone:916-442-4985
Mailing Address - Fax:
Practice Address - Street 1:3990 INDUSTRIAL BLVD
Practice Address - Street 2:
Practice Address - City:WEST SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95691-3430
Practice Address - Country:US
Practice Address - Phone:916-442-4985
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:C O R E MEDICAL CLINIC INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-09-24
Last Update Date:2023-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2800XAmbulatory Health Care FacilitiesClinic/CenterMethadone