Healthcare Provider Details

I. General information

NPI: 1902968936
Provider Name (Legal Business Name): HEALTHCORE HOMECARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/15/2006
Last Update Date: 10/10/2024
Certification Date: 10/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 NAVAHO DR. SUITE 101
RALEIGH NC
27609-7335
US

IV. Provider business mailing address

1001 NAVAHO DR. SUITE 101
RALEIGH NC
27609-7335
US

V. Phone/Fax

Practice location:
  • Phone: 919-872-1178
  • Fax: 919-872-1170
Mailing address:
  • Phone: 919-872-1178
  • Fax: 919-872-1170

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License NumberHC2378
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number State

VIII. Authorized Official

Name: IJEOMA E NWAEZE
Title or Position: EXECUTIVE DIRECTOR
Credential: RN, NP, MSN
Phone: 919-872-1178