Provider Demographics
NPI:1275004970
Name:TOTAL LIFE CONCIERGE, LLC
Entity Type:Organization
Organization Name:TOTAL LIFE CONCIERGE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL NURSE SPECIALIST, APRN
Authorized Official - Prefix:
Authorized Official - First Name:JARED
Authorized Official - Middle Name:ANDREW
Authorized Official - Last Name:MORT
Authorized Official - Suffix:
Authorized Official - Credentials:APRN, ACNS-BC
Authorized Official - Phone:210-488-8143
Mailing Address - Street 1:30301 NORTHWESTERN HWY STE 200
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48334-3278
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:30301 NORTHWESTERN HWY STE 200
Practice Address - Street 2:
Practice Address - City:FARMINGTON HILLS
Practice Address - State:MI
Practice Address - Zip Code:48334-3278
Practice Address - Country:US
Practice Address - Phone:888-674-4852
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-12-06
Last Update Date:2018-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization