MEDICARE: CORE HEALTHCARE 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	363LF0000X	Family Nurse Practitioner

General Provider Information

NPI Number	:	1629935895
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CORE HEALTHCARE LLC

Provider Business Mailing Address
First Line	:	9600 TWO NOTCH RD STE 5
Second Line	:
City	:	COLUMBIA
State	:	SC
Zip	:	29223-1612
Country	:	US
Telephone Number	:	803-887-1277
Fax Number	:

Provider Business Practice Location Address
First Line	:	9600 TWO NOTCH RD STE 5
Second Line	:
City	:	COLUMBIA
State	:	SC
Zip	:	29223-1612
Country	:	US
Telephone Number	:	803-421-9711
Fax Number	:

Authorized Official
Title or Position	:	MANAGING MEMBER
Name	:	IMAN J ABDUL-ALI
Credential	:	APRN
Telephone Number	:	803-421-9711

Provider Enumeration Date	:	01/08/2026
Last Update Date	:	01/08/2026

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Directions to “CORE HEALTHCARE LLC ” Practice Location

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