Provider Demographics
NPI:1992855266
Name:CONCORD HOME CARE INC
Entity Type:Organization
Organization Name:CONCORD HOME CARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:IFEOMA
Authorized Official - Middle Name:JACQUELINE
Authorized Official - Last Name:OKOLO
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:210-731-8996
Mailing Address - Street 1:303 W SUNSET RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78209-1749
Mailing Address - Country:US
Mailing Address - Phone:210-731-8996
Mailing Address - Fax:210-731-8895
Practice Address - Street 1:303 W SUNSET RD
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78209-1749
Practice Address - Country:US
Practice Address - Phone:210-822-9507
Practice Address - Fax:210-822-9564
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-11
Last Update Date:2010-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX005170332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX024184603Medicaid
TX024184602Medicaid
TX3875170001Medicare NSC