Provider Demographics
NPI:1659864676
Name:CONCEPT STAFFING SERVICES INC.
Entity Type:Organization
Organization Name:CONCEPT STAFFING SERVICES INC.
Other - Org Name:CONCEPT HOME CARE SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:BEVERLY
Authorized Official - Middle Name:
Authorized Official - Last Name:FAGAN
Authorized Official - Suffix:
Authorized Official - Credentials:NA
Authorized Official - Phone:954-601-6706
Mailing Address - Street 1:PO BOX 551116
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33355-1116
Mailing Address - Country:US
Mailing Address - Phone:954-601-6706
Mailing Address - Fax:954-729-8034
Practice Address - Street 1:5189 SW 122ND TER
Practice Address - Street 2:
Practice Address - City:COOPER CITY
Practice Address - State:FL
Practice Address - Zip Code:33330-4485
Practice Address - Country:US
Practice Address - Phone:954-601-6706
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-06-13
Last Update Date:2018-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL232313253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care