Corecare Behavioral Health Management, Inc.

Primary specialty

Substance Abuse Rehabilitation FacilityTaxonomy code 324500000X

Legal business name

CORECARE BEHAVIORAL HEALTH MANAGEMENT, INC.

Doing business as

Kirkbride Center

Practice address

111 N 49TH St
Philadelphia, PA 19139-2718

Phone

(215) 471-2687

Fax

(215) 471-2845

NPI assigned

Jun 3, 2008

Organization subpart

No

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

Authorized official

Name

Miss Rose Diottavio

Title

President/Ceo

Phone

(215) 471-2358

Specialties & licenses 3

Addresses

Other identifiers 1

Other names 1

• Kirkbride Center Doing business as

Medicare fee-for-service enrollment

Enrolled in PA

Opioid treatment program

Medicare-enrolled since Jan 1, 2020

Enrollment records 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Fred Baurer, M.D.

  • Addiction Psychiatry Physician
  • Philadelphia, PA
  • NPI 1477676328
  NPD (past)

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

{
    "created_epoch": "1212451200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1578873600000",
    "number": "1558520841",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "111 N 49TH ST",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191392718",
            "telephone_number": "215-471-2687",
            "fax_number": "215-471-2845"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "111 N 49TH ST",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191392718",
            "telephone_number": "215-471-2687",
            "fax_number": "215-471-2845"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CORECARE BEHAVIORAL HEALTH MANAGEMENT, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-06-03",
        "last_updated": "2020-01-13",
        "certification_date": "2020-01-13",
        "status": "A",
        "authorized_official_last_name": "DIOTTAVIO",
        "authorized_official_first_name": "ROSE",
        "authorized_official_title_or_position": "PRESIDENT/CEO",
        "authorized_official_telephone_number": "215-471-2358",
        "authorized_official_name_prefix": "Miss"
    },
    "taxonomies": [
        {
            "code": "261QR0405X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation, Substance Use Disorder",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "324500000X",
            "taxonomy_group": "",
            "desc": "Substance Abuse Rehabilitation Facility",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "3245S0500X",
            "taxonomy_group": "",
            "desc": "Substance Abuse Rehabilitation Facility, Substance Abuse Treatment, Children",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1007737600002",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Kirkbride Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Core Performance and Rehabilitation
• Core Performance Physicians
• Core Performance Physicians, LLC
• Core Wellness Centers LLC
• Corecare Behavioral Health
• Freda Coren, MD
• Gary Stephen Coren, MD
• Megumi Kondo Corley, DMD
• Eli Joseph Cornblath, MD, PHD
• Corneal Associates, PC

• Substance Abuse Rehabilitation Facility in Philadelphia, PA
• Providers in Philadelphia, PA by specialty
• Substance Abuse Rehabilitation Facility in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 13, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.