Healthcare Provider Details

I. General information

NPI: 1093912768
Provider Name (Legal Business Name): C.O.R.E.,LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/27/2007
Last Update Date: 07/22/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4555 W SCHROEDER DR STE 185
BROWN DEER WI
53223-1494
US

IV. Provider business mailing address

4555 W SCHROEDER DR STE 185
BROWN DEER WI
53223-1494
US

V. Phone/Fax

Practice location:
  • Phone: 414-586-0222
  • Fax: 414-586-0236
Mailing address:
  • Phone: 414-586-0222
  • Fax: 414-586-0236

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM2800X
TaxonomyMethadone Clinic
License Number
License Number State

VIII. Authorized Official

Name: MR. DAVID DROPKIN
Title or Position: OWNER
Credential: MA, LC, LMFT
Phone: 414-586-0222