Healthcare Provider Details

I. General information

NPI: 1104066745
Provider Name (Legal Business Name): CONCIERGE HOME HEALTH CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/23/2009
Last Update Date: 04/12/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

333 W SAN CARLOS ST SUITE 1680
SAN JOSE CA
95110
US

IV. Provider business mailing address

333 W SAN CARLOS ST SUITE 1680
SAN JOSE CA
95110
US

V. Phone/Fax

Practice location:
  • Phone: 408-287-5007
  • Fax: 408-287-3505
Mailing address:
  • Phone: 408-287-5007
  • Fax: 408-287-3505

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number550001204
License Number StateCA

VIII. Authorized Official

Name: GREGORY ARECHIGA
Title or Position: CEO/PRESIDENT
Credential:
Phone: 408-287-5007