Healthcare Provider Details

I. General information

NPI: 1265461818
Provider Name (Legal Business Name): CORA HEALTH SERVICES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/03/2006
Last Update Date: 10/04/2023
Certification Date: 10/04/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1707 NW SAINT LUCIE WEST BLVD STE 188
PORT ST LUCIE FL
34986-2521
US

IV. Provider business mailing address

PO BOX 150
LIMA OH
45802-0150
US

V. Phone/Fax

Practice location:
  • Phone: 772-878-3322
  • Fax: 772-878-5030
Mailing address:
  • Phone: 419-221-6717
  • Fax: 419-222-0507

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0400X
TaxonomyRehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. STEPHEN KRZYMINSKI
Title or Position: EXECUTIVE VICE PRESIDENT
Credential:
Phone: 419-221-6717