Healthcare Provider Details

I. General information

NPI: 1073436747
Provider Name (Legal Business Name): CORE CARE COMMUNITY SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/31/2026
Last Update Date: 07/31/2026
Certification Date: 07/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4701 OWENS WAY
PRINCE GEORGE VA
23875-2366
US

IV. Provider business mailing address

PO BOX 294
MCDONOUGH GA
30253-0294
US

V. Phone/Fax

Practice location:
  • Phone: 804-930-4890
  • Fax:
Mailing address:
  • Phone: 804-930-4890
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: KEASIA MONIQUE DAY
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 804-930-4890