Provider Demographics
NPI:1720129372
Name:CORE FAMILY CARE INC.
Entity Type:Organization
Organization Name:CORE FAMILY CARE INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:WALLACE
Authorized Official - Middle Name:RAY
Authorized Official - Last Name:CORE
Authorized Official - Suffix:
Authorized Official - Credentials:VP
Authorized Official - Phone:910-892-1711
Mailing Address - Street 1:248 JONESBORO RD
Mailing Address - Street 2:
Mailing Address - City:DUNN
Mailing Address - State:NC
Mailing Address - Zip Code:28334-6239
Mailing Address - Country:US
Mailing Address - Phone:910-892-1711
Mailing Address - Fax:910-892-5343
Practice Address - Street 1:248 JONESBORO RD
Practice Address - Street 2:
Practice Address - City:DUNN
Practice Address - State:NC
Practice Address - Zip Code:28334-6239
Practice Address - Country:US
Practice Address - Phone:910-892-1711
Practice Address - Fax:910-892-5343
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCHAL-043-001311ZA0620X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7801340Medicaid