Healthcare Provider Details

I. General information

NPI: 1215646146
Provider Name (Legal Business Name): CORE SUPPORT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/18/2022
Last Update Date: 11/18/2022
Certification Date: 11/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

221 BROADMOOR CT UNIT 6
UNION NJ
07083-8757
US

IV. Provider business mailing address

221 BROADMOOR CT UNIT 6
UNION NJ
07083-8757
US

V. Phone/Fax

Practice location:
  • Phone: 716-622-4370
  • Fax:
Mailing address:
  • Phone: 716-622-4370
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: TAMARA TRUEHEART
Title or Position: ADMINISTRATOR
Credential:
Phone: 716-622-4370