Provider Demographics
NPI:1912476854
Name:CORE THERAPUTIC CENTER LLC
Entity Type:Organization
Organization Name:CORE THERAPUTIC CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:CHRISTINE
Authorized Official - Middle Name:
Authorized Official - Last Name:HANNA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:626-831-7711
Mailing Address - Street 1:1750 E OCEAN BLVD UNIT 1305B
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90802-6060
Mailing Address - Country:US
Mailing Address - Phone:626-831-7711
Mailing Address - Fax:
Practice Address - Street 1:1750 E OCEAN BLVD UNIT 1305B
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90802-6060
Practice Address - Country:US
Practice Address - Phone:626-831-7711
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-21
Last Update Date:2018-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty