MEDICARE: HEALTHCORE RESOURCE INC

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	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1154697266
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HEALTHCORE RESOURCE INC

Provider Business Mailing Address
First Line	:	1001 NAVAHO DR STE 210
Second Line	:
City	:	RALEIGH
State	:	NC
Zip	:	27609-7318
Country	:	US
Telephone Number	:	919-872-1178
Fax Number	:	919-872-1170

Provider Business Practice Location Address
First Line	:	1831 WEEKSVILLE RD
Second Line	:	SUITE L
City	:	ELIZABETH CITY
State	:	NC
Zip	:	27909-7721
Country	:	US
Telephone Number	:	919-872-1178
Fax Number	:	919-872-1170

Authorized Official
Title or Position	:	QM DIRECTOR
Name	:	IJEOMA NWAEZE
Credential	:
Telephone Number	:	919-872-1178

Provider Enumeration Date	:	03/23/2012
Last Update Date	:	03/23/2012

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