Provider Demographics
NPI:1386024412
Name:CONCERTO HEALTHCARE OF MICHIGAN, INC.
Entity Type:Organization
Organization Name:CONCERTO HEALTHCARE OF MICHIGAN, INC.
Other - Org Name:FSC OF MICHIGAN SERVICES, INC.
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:MS
Authorized Official - First Name:CINDY
Authorized Official - Middle Name:RITA
Authorized Official - Last Name:BECKER
Authorized Official - Suffix:
Authorized Official - Credentials:ESQ
Authorized Official - Phone:949-398-8413
Mailing Address - Street 1:15606 SOUTHFIELD RD
Mailing Address - Street 2:
Mailing Address - City:ALLEN PARK
Mailing Address - State:MI
Mailing Address - Zip Code:48101-2513
Mailing Address - Country:US
Mailing Address - Phone:313-748-4200
Mailing Address - Fax:
Practice Address - Street 1:15606 SOUTHFIELD RD
Practice Address - Street 2:
Practice Address - City:ALLEN PARK
Practice Address - State:MI
Practice Address - Zip Code:48101-2513
Practice Address - Country:US
Practice Address - Phone:313-748-4200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CONCERTO HEALTHCARE OF MICHIGAN, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-06-03
Last Update Date:2015-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care