Provider Demographics
NPI:1790722031
Name:CONCEPT HOUSE, INC.
Entity Type:Organization
Organization Name:CONCEPT HOUSE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:
Authorized Official - Last Name:GISSEN
Authorized Official - Suffix:
Authorized Official - Credentials:JD, LMHC
Authorized Official - Phone:305-751-6501
Mailing Address - Street 1:162 NE 49TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33137-3118
Mailing Address - Country:US
Mailing Address - Phone:305-751-6501
Mailing Address - Fax:305-756-8906
Practice Address - Street 1:3180 BISCAYNE BLVD
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33137-4127
Practice Address - Country:US
Practice Address - Phone:305-751-6501
Practice Address - Fax:305-756-8906
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1113AD381002324500000X, 3245S0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
Not Answered3245S0500XResidential Treatment FacilitiesSubstance Abuse Rehabilitation FacilitySubstance Abuse Treatment, Children