Healthcare Provider Details

I. General information

NPI: 1790722031
Provider Name (Legal Business Name): CONCEPT HOUSE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/02/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3180 BISCAYNE BLVD
MIAMI FL
33137-4127
US

IV. Provider business mailing address

162 NE 49TH ST
MIAMI FL
33137-3118
US

V. Phone/Fax

Practice location:
  • Phone: 305-751-6501
  • Fax: 305-756-8906
Mailing address:
  • Phone: 305-751-6501
  • Fax: 305-756-8906

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number1113AD381002
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code3245S0500X
TaxonomyChildren's Substance Abuse Rehabilitation Facility
License Number1113AD381002
License Number StateFL

VIII. Authorized Official

Name: MR. MATTHEW GISSEN
Title or Position: PRESIDENT
Credential: JD, LMHC
Phone: 305-751-6501