Provider Demographics
NPI:1467045682
Name:CONCERTOHEALTH OF NORTHERN VIRGINIA, LLC
Entity Type:Organization
Organization Name:CONCERTOHEALTH OF NORTHERN VIRGINIA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:ALFREDO
Authorized Official - Last Name:MARTINEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:949-668-4902
Mailing Address - Street 1:21750 HARDY OAK BLVD STE 104
Mailing Address - Street 2:PMB 72961
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78258-4946
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1901 N BEAUREGARD ST STE 110
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22311-1721
Practice Address - Country:US
Practice Address - Phone:313-407-3807
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PERFECT HEALTH INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-02-18
Last Update Date:2021-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251T00000XAgenciesProgram of All-Inclusive Care for the Elderly (PACE) Provider Organization