MEDICARE: CONCEPT CARE AT HOME

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	253Z00000X	In Home Supportive Care Agency

General Provider Information

NPI Number	:	1235996737
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CONCEPT CARE AT HOME

Provider Business Mailing Address
First Line	:	3222 MISHAWAKA AVE
Second Line	:
City	:	SOUTH BEND
State	:	IN
Zip	:	46615-2352
Country	:	US
Telephone Number	:	574-387-5459
Fax Number	:

Provider Business Practice Location Address
First Line	:	3222 MISHAWAKA AVE
Second Line	:
City	:	SOUTH BEND
State	:	IN
Zip	:	46615-2352
Country	:	US
Telephone Number	:	574-387-5459
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR OF OPERATIONS
Name	:	BROOKE WHITE
Credential	:	PTA
Telephone Number	:	154-514-9296

Provider Enumeration Date	:	03/01/2024
Last Update Date	:	03/01/2024

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Directions to “CONCEPT CARE AT HOME ” Practice Location

Language	Start Address	Practice Location

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