Corey Kare Home & Community Support Services, LLC

Primary specialty

Developmentally Disabled Services Day Training AgencyTaxonomy code 251C00000X

License

229501 Issued in FL

Legal business name

COREY KARE HOME & COMMUNITY SUPPORT SERVICES, LLC

Practice address

5101 NW Newark LN
Port Saint Lucie, FL 34983-5369

Phone

(772) 344-8482

Fax

(772) 344-8482

NPI assigned

Jul 17, 2006

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Roderick Germaine Dixon Sr.

Title

Owner

Phone

(772) 216-8314

Specialties & licenses 1

Addresses

Other identifiers 2

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1153094400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1241913600000",
    "number": "1013934660",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5101 NW NEWARK LN",
            "city": "PORT SAINT LUCIE",
            "state": "FL",
            "postal_code": "349835369",
            "telephone_number": "772-344-8482",
            "fax_number": "772-344-8482"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5101 NW NEWARK LN",
            "city": "PORT SAINT LUCIE",
            "state": "FL",
            "postal_code": "349835369",
            "telephone_number": "772-344-8482",
            "fax_number": "772-344-8482"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COREY KARE HOME & COMMUNITY SUPPORT SERVICES, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-17",
        "last_updated": "2009-05-10",
        "status": "A",
        "authorized_official_last_name": "DIXON",
        "authorized_official_first_name": "RODERICK",
        "authorized_official_middle_name": "GERMAINE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "772-216-8314",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_name_suffix": "Sr."
    },
    "taxonomies": [
        {
            "code": "251C00000X",
            "taxonomy_group": "",
            "desc": "Day Training, Developmentally Disabled Services",
            "state": "FL",
            "license": "229501",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "688595198",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "688595196",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Developmentally Disabled Services Day Training Agency in Port Saint Lucie, FL
• Providers in Port Saint Lucie, FL by specialty
• Developmentally Disabled Services Day Training Agency in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 10, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.