Provider Demographics
NPI:1922683903
Name:COR THERAPEUTIC SERVICES, LLC
Entity Type:Organization
Organization Name:COR THERAPEUTIC SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COOWNER
Authorized Official - Prefix:
Authorized Official - First Name:NICKY
Authorized Official - Middle Name:
Authorized Official - Last Name:KETTLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:402-500-6870
Mailing Address - Street 1:1800 W PASEWALK AVE STE A
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:NE
Mailing Address - Zip Code:68701-5657
Mailing Address - Country:US
Mailing Address - Phone:402-500-6870
Mailing Address - Fax:402-500-6871
Practice Address - Street 1:614 N 4TH ST STE 104
Practice Address - Street 2:
Practice Address - City:ONEILL
Practice Address - State:NE
Practice Address - Zip Code:68763-1317
Practice Address - Country:US
Practice Address - Phone:402-500-6870
Practice Address - Fax:402-500-6871
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-11
Last Update Date:2021-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty