Provider Demographics
NPI:1417328527
Name:CONCERTO HEALTHCARE OF WASHINGTON, INC.
Entity Type:Organization
Organization Name:CONCERTO HEALTHCARE OF WASHINGTON, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:MS
Authorized Official - First Name:CINDY
Authorized Official - Middle Name:
Authorized Official - Last Name:BECKER
Authorized Official - Suffix:
Authorized Official - Credentials:ESQ
Authorized Official - Phone:949-398-8413
Mailing Address - Street 1:2030 MAIN ST
Mailing Address - Street 2:600
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92614-7219
Mailing Address - Country:US
Mailing Address - Phone:949-398-8413
Mailing Address - Fax:
Practice Address - Street 1:8815 S TACOMA WAY
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:WA
Practice Address - Zip Code:98499-4587
Practice Address - Country:US
Practice Address - Phone:949-398-8413
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CONCERTO HEALTHCARE, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-10-14
Last Update Date:2015-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service