Healthcare Provider Details

I. General information

NPI: 1598063307
Provider Name (Legal Business Name): CORINE'S CARE MANAGEMENT, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/02/2011
Last Update Date: 03/02/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

369 B C HWY 13 SOUTH
SNOW HILL NC
28580-9515
US

IV. Provider business mailing address

55 PATRICK DR
SNOW HILL NC
28580-9515
US

V. Phone/Fax

Practice location:
  • Phone: 252-747-5705
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier5950446
Identifier TypeMEDICAID
Identifier StateNC
Identifier Issuer

VIII. Authorized Official

Name: WATOANAR FLANAGAN
Title or Position: PRESIDET
Credential:
Phone: 252-747-5705