MEDICARE: CORE SERVICES & SUPPORT 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	251C00000X	Developmentally Disabled Services Day Training Agency

General Provider Information

NPI Number	:	1891540274
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CORE SERVICES & SUPPORT LLC.

Provider Business Mailing Address
First Line	:	601 HIGH ST
Second Line	:
City	:	PORTSMOUTH
State	:	VA
Zip	:	23704-3423
Country	:	US
Telephone Number	:	757-606-0154
Fax Number	:

Provider Business Practice Location Address
First Line	:	601 HIGH ST
Second Line	:
City	:	PORTSMOUTH
State	:	VA
Zip	:	23704-3423
Country	:	US
Telephone Number	:	757-606-0154
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	SHANTE HALL
Credential	:
Telephone Number	:	757-606-0154

Provider Enumeration Date	:	04/19/2024
Last Update Date	:	04/19/2024

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