Healthcare Provider Details

I. General information

NPI: 1144793068
Provider Name (Legal Business Name): CONCISE CARE GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/03/2019
Last Update Date: 01/05/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

145 N PRAIRE AVE
INGLEWOOD CA
90301-1904
US

IV. Provider business mailing address

145 N PRAIRIE AVE
INGLEWOOD CA
90301-1904
US

V. Phone/Fax

Practice location:
  • Phone: 323-529-3269
  • Fax: 323-545-3156
Mailing address:
  • Phone: 323-529-3269
  • Fax: 323-545-3156

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251X00000X
TaxonomySupports Brokerage Agency
License Number
License Number State

VIII. Authorized Official

Name: CHANNON MELLISA MITCHELL
Title or Position: CEO/CFO/SEC
Credential:
Phone: 323-529-3269