MEDICARE: NURSECORE MANAGEMENT SERVICES-NEW YORK, L.L.C.

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	251E00000X	Home Health Agency	1798-L001	NY

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	:	1407125271
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NURSECORE MANAGEMENT SERVICES-NEW YORK, L.L.C.

Provider Business Mailing Address
First Line	:	PO BOX 201925
Second Line	:
City	:	ARLINGTON
State	:	TX
Zip	:	76006-1925
Country	:	US
Telephone Number	:	817-649-1166
Fax Number	:	817-649-5532

Provider Business Practice Location Address
First Line	:	1302 SCOTTSVILLE RD
Second Line	:
City	:	ROCHESTER
State	:	NY
Zip	:	14624-5128
Country	:	US
Telephone Number	:	585-341-4499
Fax Number	:	585-341-4498

Authorized Official
Title or Position	:	PRESIDENT / CEO
Name	:	MRS. DEBORAH LOLLAR
Credential	:
Telephone Number	:	817-649-1166

Provider Enumeration Date	:	12/22/2011
Last Update Date	:	04/19/2022

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