=====================================================
General NPI Number Information
=====================================================
NPI Number | 1720523699
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CORE VALUES LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/30/2016
-----------------------------------------------------
Last Update Date | 12/30/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1611 MAIN ST SUITE 203
-----------------------------------------------------
City | WOODWARD
-----------------------------------------------------
State | OK
-----------------------------------------------------
Zip | 73801-3021
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 580-290-5144
-----------------------------------------------------
Fax | 580-290-5145
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1611 MAIN ST SUITE 203
-----------------------------------------------------
City | WOODWARD
-----------------------------------------------------
State | OK
-----------------------------------------------------
Zip | 73801-3021
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 580-290-5144
-----------------------------------------------------
Fax | 580-290-5145
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | REBECCA AVANTS
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 580-290-5144
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 332S00000X
-----------------------------------------------------
Taxonomy Name | Hearing Aid Equipment
-----------------------------------------------------
License Number | 1147
-----------------------------------------------------
License Number State | OK
-----------------------------------------------------