=====================================================
General NPI Number Information
=====================================================
NPI Number | 1942207675
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CORE HOLDINGS, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/07/2005
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 26555 CARMEL RANCHO BLVD
-----------------------------------------------------
City | CARMEL
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 93923-8748
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 831-622-1850
-----------------------------------------------------
Fax | 831-622-1855
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2124 MAIN ST
-----------------------------------------------------
City | HUNTINGTON BEACH
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92648-6443
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 714-969-2342
-----------------------------------------------------
Fax | 714-969-3160
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT, CEO
-----------------------------------------------------
Name | MR. GARY A. VERGILIO
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 714-969-2342
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number | 0700260
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------