Provider Demographics
NPI: | 1982117446 |
---|---|
Name: | CORA HEALTH SERVICES INC |
Entity type: | Organization |
Organization Name: | CORA HEALTH SERVICES INC |
Other - Org Name: | <UNAVAIL> |
Other - Org Type: | |
Authorized Official - Title/Position: | EXECUTIVE VICE PRESIDENT |
Authorized Official - Prefix: | |
Authorized Official - First Name: | STEPHEN |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | KRZYMINSKI |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 419-221-6717 |
Mailing Address - Street 1: | PO BOX 150 |
Mailing Address - Street 2: | |
Mailing Address - City: | LIMA |
Mailing Address - State: | OH |
Mailing Address - Zip Code: | 45802-0150 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 419-221-6717 |
Mailing Address - Fax: | 419-222-0507 |
Practice Address - Street 1: | 9560 CROSSHILL BLVD |
Practice Address - Street 2: | |
Practice Address - City: | JACKSONVILLE |
Practice Address - State: | FL |
Practice Address - Zip Code: | 32222-5850 |
Practice Address - Country: | US |
Practice Address - Phone: | 904-573-0046 |
Practice Address - Fax: | 904-573-0772 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2017-11-07 |
Last Update Date: | 2023-09-28 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
FL | 261QR0400X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 261QR0400X | Ambulatory Health Care Facilities | Clinic/Center | Rehabilitation |