Provider Demographics
NPI:1376122283
Name:CONCORDIA HEALTH CENTERS LLC
Entity Type:Organization
Organization Name:CONCORDIA HEALTH CENTERS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:DECEMBER
Authorized Official - Middle Name:CRYSTAL
Authorized Official - Last Name:NUNEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-603-9731
Mailing Address - Street 1:9627 S DIXIE HWY STE 100
Mailing Address - Street 2:
Mailing Address - City:PINECREST
Mailing Address - State:FL
Mailing Address - Zip Code:33156-2804
Mailing Address - Country:US
Mailing Address - Phone:305-603-9731
Mailing Address - Fax:
Practice Address - Street 1:9627 S DIXIE HWY STE 100
Practice Address - Street 2:
Practice Address - City:PINECREST
Practice Address - State:FL
Practice Address - Zip Code:33156-2804
Practice Address - Country:US
Practice Address - Phone:305-603-9731
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-07
Last Update Date:2022-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care