Provider Demographics
NPI:1790030971
Name:CORA HEALTH SERVICES
Entity Type:Organization
Organization Name:CORA HEALTH SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SENIOR CLINIC MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KIM
Authorized Official - Middle Name:
Authorized Official - Last Name:PRICE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:863-471-1223
Mailing Address - Street 1:3503 DAUPHINE ST
Mailing Address - Street 2:
Mailing Address - City:SEBRING
Mailing Address - State:FL
Mailing Address - Zip Code:33872-2890
Mailing Address - Country:US
Mailing Address - Phone:863-385-4980
Mailing Address - Fax:
Practice Address - Street 1:6120 US HIGHWAY 27 N
Practice Address - Street 2:
Practice Address - City:SEBRING
Practice Address - State:FL
Practice Address - Zip Code:33870-1221
Practice Address - Country:US
Practice Address - Phone:863-471-1223
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-13
Last Update Date:2012-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL3168174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty