1548204886 NPI number — NURSECORE MANAGEMENT SERVICES, LLC

Table of content: CINDY WALEAH GILLIS DPH (NPI 1497868228)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1548204886 NPI number — NURSECORE MANAGEMENT SERVICES, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NURSECORE MANAGEMENT SERVICES, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
NURSECORE OF LAS VEGAS
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1548204886
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/19/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 201925
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ARLINGTON
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
76006-1925
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
817-649-1166
Provider Business Mailing Address Fax Number:
817-649-2638

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4423 W FLAMINGO RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LAS VEGAS
Provider Business Practice Location Address State Name:
NV
Provider Business Practice Location Address Postal Code:
89103-3703
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
702-458-1137
Provider Business Practice Location Address Fax Number:
702-458-1423
Provider Enumeration Date:
06/16/2006

Additional Information

Authorized Official

Authorized Official Last Name:
LOLLAR
Authorized Official First Name:
DEBORAH
Authorized Official Middle Name:
Y
Authorized Official Title or Position:
PRESIDENT / CEO
Authorized Official Telephone Number:
817-649-1166

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X , with the licence number:  580HHA , registered in the state of NV ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 2902029 , issued by the state of ( NV ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com