Provider Demographics
NPI:1063690212
Name:CORECARE, LLC
Entity type:Organization
Organization Name:CORECARE, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER / CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:FREDERICK
Authorized Official - Middle Name:EARL
Authorized Official - Last Name:KIMBLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-877-1616
Mailing Address - Street 1:1120 SOUTH FWY
Mailing Address - Street 2:SUITE 209
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76104-5064
Mailing Address - Country:US
Mailing Address - Phone:817-877-1616
Mailing Address - Fax:817-334-7994
Practice Address - Street 1:1120 SOUTH FWY
Practice Address - Street 2:SUITE 209
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104-5064
Practice Address - Country:US
Practice Address - Phone:817-877-1616
Practice Address - Fax:817-334-7994
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-08
Last Update Date:2011-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX011418311ZA0620X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home