Provider Demographics
NPI:1770515330
Name:CONCORD HOME CARE, INC
Entity type:Organization
Organization Name:CONCORD HOME CARE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:C.E.O.
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:SUITE 200
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78209-1749
Practice Address - Country:US
Practice Address - Phone:210-731-8996
Practice Address - Fax:210-731-8895
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX005170251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX459033Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER