Healthcare Provider Details

I. General information

NPI: 1558803981
Provider Name (Legal Business Name): CONCIERGE CENTERED CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/16/2016
Last Update Date: 11/16/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4503 HAVENWOOD DR
GREENSBORO NC
27407-3034
US

IV. Provider business mailing address

4503 HAVENWOOD DR
GREENSBORO NC
27407-3034
US

V. Phone/Fax

Practice location:
  • Phone: 919-923-0348
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number34D2113637
License Number StateNC

VIII. Authorized Official

Name: KARYSHA REID
Title or Position: DIRECTOR
Credential:
Phone: 919-923-0348