Provider Demographics
NPI:1588191274
Name:CONCORD HOME HEALTH CARE
Entity Type:Organization
Organization Name:CONCORD HOME HEALTH CARE
Other - Org Name:ALLOY HEALTH GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MARUT
Authorized Official - Middle Name:
Authorized Official - Last Name:ANTONIAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-209-1919
Mailing Address - Street 1:6824 RADFORD AVE
Mailing Address - Street 2:SUITE 1
Mailing Address - City:NORTH HOLLYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:91605
Mailing Address - Country:US
Mailing Address - Phone:818-209-1919
Mailing Address - Fax:
Practice Address - Street 1:6824 RADFORD AVE
Practice Address - Street 2:SUITE 1
Practice Address - City:NORTH HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:91605
Practice Address - Country:US
Practice Address - Phone:818-209-1919
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-12
Last Update Date:2017-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA11432906251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA058215OtherTO SERVICE MANAGED CARE PATIENTS THAT HAVE OON BENIFITS