Provider Demographics
NPI:1538450150
Name:CORE HEALTH, LLC
Entity type:Organization
Organization Name:CORE HEALTH, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:BRADLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:POPPIE
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:720-982-2000
Mailing Address - Street 1:PO BOX 727
Mailing Address - Street 2:
Mailing Address - City:WESTMINSTER
Mailing Address - State:CO
Mailing Address - Zip Code:80036-0727
Mailing Address - Country:US
Mailing Address - Phone:720-982-1059
Mailing Address - Fax:720-344-5787
Practice Address - Street 1:5165 W 72ND AVE STE B
Practice Address - Street 2:
Practice Address - City:WESTMINSTER
Practice Address - State:CO
Practice Address - Zip Code:80030-5137
Practice Address - Country:US
Practice Address - Phone:720-982-1059
Practice Address - Fax:720-344-5787
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-29
Last Update Date:2011-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO7428261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO483718Medicare PIN