Provider Demographics
NPI:1649934738
Name:CONCERTO HEALTH PACE OF LOS ANGELES, LLC
Entity type:Organization
Organization Name:CONCERTO HEALTH PACE OF LOS ANGELES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SVP, GENERAL COUNSEL AND COMPLIANCE
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:BRYANT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:949-689-9526
Mailing Address - Street 1:21750 HARDY OAK BLVD., STE. 104, PMB 72961
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78258-4946
Mailing Address - Country:US
Mailing Address - Phone:877-597-1440
Mailing Address - Fax:
Practice Address - Street 1:3670 DEGNAN BOULEVARD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90018
Practice Address - Country:US
Practice Address - Phone:213-328-9666
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-26
Last Update Date:2021-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251T00000XAgenciesProgram of All-Inclusive Care for the Elderly (PACE) Provider Organization