Healthcare Provider Details

I. General information

NPI: 1912316480
Provider Name (Legal Business Name): NURSECORE MANAGEMENT SERVICES-NEW YORK, L.L.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/08/2014
Last Update Date: 04/19/2022
Certification Date: 04/19/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 PALMA DR STE 243-245
VENTURA CA
93003-6451
US

IV. Provider business mailing address

PO BOX 201925
ARLINGTON TX
76006-1925
US

V. Phone/Fax

Practice location:
  • Phone: 805-535-1099
  • Fax:
Mailing address:
  • Phone: 817-649-1166
  • Fax: 817-649-5532

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number550003103
License Number StateCA

VIII. Authorized Official

Name: DEBORAH LOLLAR
Title or Position: PRESIDENT / CEO
Credential:
Phone: 817-649-1166