1831285782 NPI number — CONCORD HOME HEALTH SERVICES, LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1831285782 NPI number — CONCORD HOME HEALTH SERVICES, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CONCORD HOME HEALTH 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:
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:
1831285782
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/12/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2305 OAK LN STE 209
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GRAND PRAIRIE
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75051-8241
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
817-465-5001
Provider Business Mailing Address Fax Number:
817-465-5002

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2305 OAK LN STE 209
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GRAND PRAIRIE
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75051-8241
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
817-465-5001
Provider Business Practice Location Address Fax Number:
817-465-5002
Provider Enumeration Date:
10/05/2006

Additional Information

Authorized Official

Authorized Official Last Name:
THORPE
Authorized Official First Name:
GENNY
Authorized Official Middle Name:
RONKE
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
817-465-5001

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X , with the licence number:  008830 , 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: 001025739 . This is a "CDSA MDCP PROGRAM" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 001025738 . This is a "CDSA PHC PROGRAM" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 001013743 . This is a "PHC" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 001025740 . This is a "CDSA CLASS PROGRAM" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 1014156 . This is a "CBA" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 164342101 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




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