Provider Demographics
NPI:1851856405
Name:CORE VALUES SUPPORT SERVICE LLC
Entity Type:Organization
Organization Name:CORE VALUES SUPPORT SERVICE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PRENTIS
Authorized Official - Middle Name:
Authorized Official - Last Name:HALL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-527-7593
Mailing Address - Street 1:1870 RAMPART LN
Mailing Address - Street 2:
Mailing Address - City:LANSDALE
Mailing Address - State:PA
Mailing Address - Zip Code:19446-5051
Mailing Address - Country:US
Mailing Address - Phone:215-527-7503
Mailing Address - Fax:484-223-2935
Practice Address - Street 1:3420 WALBERT AVE UNIT 201
Practice Address - Street 2:
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18104-1700
Practice Address - Country:US
Practice Address - Phone:215-527-7503
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ROYAL HOME CARE SERVICES, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-02-07
Last Update Date:2019-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251X00000XAgenciesSupports Brokerage
Provider Identifiers
StateIdentifier IDID TypeIssuer
NONEOtherNONE