Provider Demographics
NPI:1588761597
Name:NURSECORE MANAGEMENT SERVICES-NEW YORK, L.L.C.
Entity type:Organization
Organization Name:NURSECORE MANAGEMENT SERVICES-NEW YORK, L.L.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:
Authorized Official - Last Name:LOLLAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-649-1166
Mailing Address - Street 1:PO BOX 201925
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76006-1925
Mailing Address - Country:US
Mailing Address - Phone:817-649-1166
Mailing Address - Fax:817-649-5532
Practice Address - Street 1:1218 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12205-5329
Practice Address - Country:US
Practice Address - Phone:518-438-3900
Practice Address - Fax:518-438-9148
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2022-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1089L001251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY04919251Medicaid