Provider Demographics
NPI:1174964142
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:
Authorized Official - Last Name:NWAEZE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:877-872-1178
Mailing Address - Street 1:1001 NAVAHO DR
Mailing Address - Street 2:SUITE 101
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27609-7335
Mailing Address - Country:US
Mailing Address - Phone:877-872-1178
Mailing Address - Fax:800-879-8149
Practice Address - Street 1:8929 J M KEYNES DR
Practice Address - Street 2:SUITE 335
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28262-8406
Practice Address - Country:US
Practice Address - Phone:919-872-1178
Practice Address - Fax:800-879-8149
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-08
Last Update Date:2013-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health