1962157008 NPI number — CONCERTOCARE PACE OF BAKERSFIELD, 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 1962157008 NPI number — CONCERTOCARE PACE OF BAKERSFIELD, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CONCERTOCARE PACE OF BAKERSFIELD, 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:
1962157008
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/17/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
21750 HARDY OAK BLVD
Provider Second Line Business Mailing Address:
SUITE 104, PMB 72961
Provider Business Mailing Address City Name:
SAN ANTONIO
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78258-4925
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
949-689-9526
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
400 WEST CUMMINGS PARK
Provider Second Line Business Practice Location Address:
SUITE 6475
Provider Business Practice Location Address City Name:
WOBUM
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01801-6519
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
949-689-9526
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/17/2022

Additional Information

Authorized Official

Authorized Official Last Name:
BRYANT
Authorized Official First Name:
JENNIFER
Authorized Official Middle Name:
Authorized Official Title or Position:
MEMBER
Authorized Official Telephone Number:
949-689-9526

Provider Taxonomy Codes

  • Taxonomy code: 251T00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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