Provider Demographics
NPI:1568818177
Name:CONCORD WELLNESS CENTER & HOME HEALTH
Entity Type:Organization
Organization Name:CONCORD WELLNESS CENTER & HOME HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:NATASHA
Authorized Official - Middle Name:L
Authorized Official - Last Name:RHONE
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:864-760-1010
Mailing Address - Street 1:4126 CLEMSON BLVD
Mailing Address - Street 2:SUITE 1A
Mailing Address - City:ANDERSON
Mailing Address - State:SC
Mailing Address - Zip Code:29621-1113
Mailing Address - Country:US
Mailing Address - Phone:864-760-1010
Mailing Address - Fax:
Practice Address - Street 1:4126 CLEMSON BLVD
Practice Address - Street 2:SUITE 1A
Practice Address - City:ANDERSON
Practice Address - State:SC
Practice Address - Zip Code:29621-1113
Practice Address - Country:US
Practice Address - Phone:864-760-1010
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-12
Last Update Date:2016-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC19338302R00000X
SC17933363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes302R00000XManaged Care OrganizationsHealth Maintenance OrganizationGroup - Single Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty