MEDICARE: CORECARE, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	311ZA0620X	Adult Care Home Facility	011418	TX

General Provider Information

NPI Number	:	1063690212
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CORECARE, LLC

Provider Business Mailing Address
First Line	:	1120 SOUTH FWY
Second Line	:	SUITE 209
City	:	FORT WORTH
State	:	TX
Zip	:	76104-5064
Country	:	US
Telephone Number	:	817-877-1616
Fax Number	:	817-334-7994

Provider Business Practice Location Address
First Line	:	1120 SOUTH FWY
Second Line	:	SUITE 209
City	:	FORT WORTH
State	:	TX
Zip	:	76104-5064
Country	:	US
Telephone Number	:	817-877-1616
Fax Number	:	817-334-7994

Authorized Official
Title or Position	:	OWNER / CEO
Name	:	MR. FREDERICK EARL KIMBLE
Credential	:
Telephone Number	:	817-877-1616

Provider Enumeration Date	:	02/08/2008
Last Update Date	:	05/13/2011

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