MEDICARE: CORE DYNAMICS LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251S00000X	Community/Behavioral Health Agency
2	251C00000X	Developmentally Disabled Services Day Training Agency

General Provider Information

NPI Number	:	1144913252
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CORE DYNAMICS LLC

Provider Business Mailing Address
First Line	:	615 ROYAL ST
Second Line	:
City	:	CALDWELL
State	:	ID
Zip	:	83605-1663
Country	:	US
Telephone Number	:	208-501-6361
Fax Number	:

Provider Business Practice Location Address
First Line	:	615 ROYAL ST
Second Line	:
City	:	CALDWELL
State	:	ID
Zip	:	83605-1663
Country	:	US
Telephone Number	:	208-501-6361
Fax Number	:

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	KRISTENE BLAIR
Credential	:
Telephone Number	:	208-501-6361

Provider Enumeration Date	:	06/02/2023
Last Update Date	:	12/09/2025

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Directions to “CORE DYNAMICS LLC ” Practice Location

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