1992855266 NPI number — CONCORD HOME CARE INC

Table of content: (NPI 1992855266)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1992855266 NPI number — CONCORD HOME CARE INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CONCORD HOME CARE INC
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:
Provider Other Organization Name Type Code:
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:
1992855266
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/20/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
303 W SUNSET RD
Provider Second Line Business Mailing Address:
SUITE 200
Provider Business Mailing Address City Name:
SAN ANTONIO
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78209-1749
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
210-731-8996
Provider Business Mailing Address Fax Number:
210-731-8895

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
303 W SUNSET RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAN ANTONIO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78209-1749
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
210-822-9507
Provider Business Practice Location Address Fax Number:
210-822-9564
Provider Enumeration Date:
01/11/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
OKOLO
Authorized Official First Name:
IFEOMA
Authorized Official Middle Name:
JACQUELINE
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
210-731-8996

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X , with the licence number:  005170 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 024184603 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 024184602 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".