Provider Demographics
NPI:1962832048
Name:HEALTHCORE RESOURCE, INC
Entity Type:Organization
Organization Name:HEALTHCORE RESOURCE, INC
Other - Org Name:HEALTHCORE ADOLESCENT RESIDENTIAL TREATMENT III
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:IJEOMA
Authorized Official - Middle Name:E
Authorized Official - Last Name:NWAEZE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-872-1178
Mailing Address - Street 1:1001 NAVAHO DR
Mailing Address - Street 2:SUITE 101
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27609-7335
Mailing Address - Country:US
Mailing Address - Phone:919-872-1178
Mailing Address - Fax:919-872-1170
Practice Address - Street 1:821 BROOKHANNAH CT
Practice Address - Street 2:
Practice Address - City:FUQUAY VARINA
Practice Address - State:NC
Practice Address - Zip Code:27526-5138
Practice Address - Country:US
Practice Address - Phone:919-872-1178
Practice Address - Fax:919-872-1170
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-26
Last Update Date:2015-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities