Provider Demographics
NPI:1992220461
Name:CONCIERGE HEALTHCARE
Entity Type:Organization
Organization Name:CONCIERGE HEALTHCARE
Other - Org Name:CONCIERGE HEALTHCARE AND CHRONIC PAIN MANAGEMENT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/ NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:JOANNE
Authorized Official - Last Name:STAHL
Authorized Official - Suffix:
Authorized Official - Credentials:ARNP
Authorized Official - Phone:763-951-2308
Mailing Address - Street 1:3260 COUNTY ROAD 10 STE G
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN CENTER
Mailing Address - State:MN
Mailing Address - Zip Code:55429-3161
Mailing Address - Country:US
Mailing Address - Phone:763-951-2308
Mailing Address - Fax:
Practice Address - Street 1:3260 COUNTY ROAD 10 STE G
Practice Address - Street 2:
Practice Address - City:BROOKLYN CENTER
Practice Address - State:MN
Practice Address - Zip Code:55429-3161
Practice Address - Country:US
Practice Address - Phone:763-951-2308
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-07
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center