Provider Demographics
NPI:1356714034
Name:COREVITACARE, INC.
Entity type:Organization
Organization Name:COREVITACARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:BELORIA
Authorized Official - Middle Name:
Authorized Official - Last Name:FINK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:888-808-0211
Mailing Address - Street 1:5173 DOUGLAS FIR RD
Mailing Address - Street 2:
Mailing Address - City:CALABASAS
Mailing Address - State:CA
Mailing Address - Zip Code:91302-1461
Mailing Address - Country:US
Mailing Address - Phone:888-808-0211
Mailing Address - Fax:888-808-0311
Practice Address - Street 1:5173 DOUGLAS FIR RD
Practice Address - Street 2:
Practice Address - City:CALABASAS
Practice Address - State:CA
Practice Address - Zip Code:91302-1461
Practice Address - Country:US
Practice Address - Phone:888-808-0211
Practice Address - Fax:888-808-0311
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-03
Last Update Date:2015-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC3835333251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00C518040Medicaid