Provider Demographics
NPI:1831285782
Name:CONCORD HOME HEALTH SERVICES, LLC
Entity Type:Organization
Organization Name:CONCORD HOME HEALTH SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:GENNY
Authorized Official - Middle Name:RONKE
Authorized Official - Last Name:THORPE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-465-5001
Mailing Address - Street 1:2305 OAK LN STE 209
Mailing Address - Street 2:
Mailing Address - City:GRAND PRAIRIE
Mailing Address - State:TX
Mailing Address - Zip Code:75051-8241
Mailing Address - Country:US
Mailing Address - Phone:817-465-5001
Mailing Address - Fax:817-465-5002
Practice Address - Street 1:2305 OAK LN STE 209
Practice Address - Street 2:
Practice Address - City:GRAND PRAIRIE
Practice Address - State:TX
Practice Address - Zip Code:75051-8241
Practice Address - Country:US
Practice Address - Phone:817-465-5001
Practice Address - Fax:817-465-5002
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-05
Last Update Date:2018-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX008830251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX001025739OtherCDSA MDCP PROGRAM
TX001025738OtherCDSA PHC PROGRAM
TX001013743OtherPHC
TX001025740OtherCDSA CLASS PROGRAM
TX1014156OtherCBA
TX164342101Medicaid
TX1014156OtherCBA