MEDICARE: CORECARE BEHAVIORAL HEALTH

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	276400000X	Substance Use Disorder Rehabilitation Hospital Unit	807208	PA
2	273Y00000X	Rehabilitation Hospital Unit	807208	PA
3	283Q00000X	Psychiatric Hospital
4	273R00000X	Psychiatric Hospital Unit	197910	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1851390561
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CORECARE BEHAVIORAL HEALTH

Provider Business Mailing Address
First Line	:	111 N 49TH ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19139-2718
Country	:	US
Telephone Number	:	215-471-2488
Fax Number	:

Provider Business Practice Location Address
First Line	:	111 N 49TH ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19139-2718
Country	:	US
Telephone Number	:	215-471-2488
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MISS ROSE S DIOTTAVIO
Credential	:
Telephone Number	:	215-471-2853

Provider Enumeration Date	:	07/15/2005
Last Update Date	:	10/22/2015

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Practice Location Address:

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1760502827 — MR. SCOTT WEISENBERGER LPC
Practice Location Address:

111 N 49TH ST
PHILADELPHIA, PA
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Practice Location Address:

111 N 49TH ST
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Practice Fax:

1477676328 — FRED BAURER M.D.
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111 N 49TH ST
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19139-2718

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