1831285782 NPI number — CONCORD HOME HEALTH SERVICES, LLC

Table of content: (NPI 1831285782)

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".




Copyright © 2007-2025 www.npivalidator.com