MEDICARE: HEALTHCORE RESOURCE, INC.

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	320600000X	Intellectual and/or Developmental Disabilities Residential Treatment Facility

General Provider Information

NPI Number	:	1225440647
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HEALTHCORE RESOURCE, INC.

Provider Business Mailing Address
First Line	:	1001 NAVAHO DR
Second Line	:	SUITE 101
City	:	RALEIGH
State	:	NC
Zip	:	27609-7335
Country	:	US
Telephone Number	:	919-872-1178
Fax Number	:	919-872-1170

Provider Business Practice Location Address
First Line	:	7625 MINE VALLEY RD
Second Line	:
City	:	RALEIGH
State	:	NC
Zip	:	27615-6017
Country	:	US
Telephone Number	:	919-872-1178
Fax Number	:	800-879-8149

Authorized Official
Title or Position	:	CEO
Name	:	IJEOMA E NWAEZE
Credential	:
Telephone Number	:	919-872-1178

Provider Enumeration Date	:	05/21/2014
Last Update Date	:	01/09/2015

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