Healthcare Provider Details

I. General information

NPI: 1790215200
Provider Name (Legal Business Name): CONCERTED CARE GROUP MANAGEMENT LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/16/2017
Last Update Date: 06/16/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

412 E 25TH ST
BALTIMORE MD
21218-5304
US

IV. Provider business mailing address

428 E 25TH ST
BALTIMORE MD
21218-5304
US

V. Phone/Fax

Practice location:
  • Phone: 410-617-0142
  • Fax: 443-873-6975
Mailing address:
  • Phone: 410-617-0142
  • Fax: 443-873-6975

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code177F00000X
TaxonomyLodging Provider
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: BARBARA WAHL
Title or Position: COO
Credential: RN, MA
Phone: 667-239-3205