Provider Demographics
NPI:1588983936
Name:HEALTHCORE RESOURCE, INC
Entity type:Organization
Organization Name:HEALTHCORE RESOURCE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:IJEOMA
Authorized Official - Middle Name:E
Authorized Official - Last Name:NWAEZE
Authorized Official - Suffix:
Authorized Official - Credentials:BSN
Authorized Official - Phone:919-872-1178
Mailing Address - Street 1:2640 YONKERS RD
Mailing Address - Street 2:SUITE 104
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27604-3268
Mailing Address - Country:US
Mailing Address - Phone:919-834-6642
Mailing Address - Fax:919-834-6643
Practice Address - Street 1:2640 YONKERS RD
Practice Address - Street 2:SUITE 104
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27604-3268
Practice Address - Country:US
Practice Address - Phone:919-834-6642
Practice Address - Fax:919-834-6643
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HEALTHCORE RESOURCE SUBSTANCE ABUSE SERVICES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-05-25
Last Update Date:2010-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCMHL-092-772251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health