Provider Demographics
NPI:1376710392
Name:CG CONCIERGE & IN HOME PERSONAL CARE
Entity Type:Organization
Organization Name:CG CONCIERGE & IN HOME PERSONAL CARE
Other - Org Name:CG CONCIERGE & IN HOME PERSONAL CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/ OPERATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:CLYDE
Authorized Official - Middle Name:L
Authorized Official - Last Name:GOSEY
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:832-382-5711
Mailing Address - Street 1:PO BOX 65131
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71136-5131
Mailing Address - Country:US
Mailing Address - Phone:832-382-5711
Mailing Address - Fax:318-688-6276
Practice Address - Street 1:718 W 71ST ST
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71106-3502
Practice Address - Country:US
Practice Address - Phone:832-382-5711
Practice Address - Fax:318-688-6276
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-08
Last Update Date:2008-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health