MEDICARE: CORA HEALTH SERVICES 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	261QR0400X	Rehabilitation Clinic/Center

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1265461818
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CORA HEALTH SERVICES INC

Provider Business Mailing Address
First Line	:	PO BOX 150
Second Line	:
City	:	LIMA
State	:	OH
Zip	:	45802-0150
Country	:	US
Telephone Number	:	419-221-6717
Fax Number	:	419-222-0507

Provider Business Practice Location Address
First Line	:	1707 NW SAINT LUCIE WEST BLVD STE 188
Second Line	:
City	:	PORT ST LUCIE
State	:	FL
Zip	:	34986-2521
Country	:	US
Telephone Number	:	772-878-3322
Fax Number	:	772-878-5030

Authorized Official
Title or Position	:	EXECUTIVE VICE PRESIDENT
Name	:	MR. STEPHEN KRZYMINSKI
Credential	:
Telephone Number	:	419-221-6717

Provider Enumeration Date	:	07/03/2006
Last Update Date	:	10/04/2023

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