Provider Demographics
NPI:1972033470
Name:CONCERTED CARE GROUP MANAGEMENT LLC
Entity Type:Organization
Organization Name:CONCERTED CARE GROUP MANAGEMENT LLC
Other - Org Name:CCG MANAGEMENT, LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:
Authorized Official - Last Name:WAHL
Authorized Official - Suffix:
Authorized Official - Credentials:RN, MA
Authorized Official - Phone:667-239-3205
Mailing Address - Street 1:428 E 25TH ST
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21218-5304
Mailing Address - Country:US
Mailing Address - Phone:410-617-0142
Mailing Address - Fax:443-873-6975
Practice Address - Street 1:416 E 26TH ST
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21218-4703
Practice Address - Country:US
Practice Address - Phone:410-617-0142
Practice Address - Fax:443-873-6975
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-16
Last Update Date:2017-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes177F00000XOther Service ProvidersLodging