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General NPI Number Information
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NPI Number | 1528376803
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Entity Type | Organization
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Legal Business Name | CORE SUPPORT INC
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Dates
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Enumeration Date | 09/20/2010
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Last Update Date | 09/30/2010
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Provider Practice Location Address
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Address Line | 9045 SW 213TH ST
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City | CUTLER BAY
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State | FL
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Zip | 33189-3831
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Country | US
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Telephone | 305-989-1483
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Fax |
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Provider Business Mailing Address
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Address Line | 17400 SW 97TH AVE STE 115
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City | PALMETTO BAY
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State | FL
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Zip | 33157-5420
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | MR. COREY MARSHALL
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Credential |
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Telephone | 305-989-1483
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number | 229911
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License Number State | FL
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