Provider Demographics
NPI:1912204314
Name:CORELIEF CENTER
Entity Type:Organization
Organization Name:CORELIEF CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:NINA
Authorized Official - Middle Name:
Authorized Official - Last Name:VARGAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:337-475-6334
Mailing Address - Street 1:2301 E PRIEN LAKE RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:LAKE CHARLES
Mailing Address - State:LA
Mailing Address - Zip Code:70601-7976
Mailing Address - Country:US
Mailing Address - Phone:337-475-6334
Mailing Address - Fax:
Practice Address - Street 1:643 DR MICHAEL DEBAKEY DR
Practice Address - Street 2:
Practice Address - City:LAKE CHARLES
Practice Address - State:LA
Practice Address - Zip Code:70601-5726
Practice Address - Country:US
Practice Address - Phone:337-475-6334
Practice Address - Fax:337-475-6327
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-21
Last Update Date:2021-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD11215R171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Single Specialty