Healthcare Provider Details

I. General information

NPI: 1619712155
Provider Name (Legal Business Name): CONCORDIA WOUND CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/26/2024
Last Update Date: 06/26/2024
Certification Date: 06/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1299 FARNAM ST STE 300
OMAHA NE
68102-1857
US

IV. Provider business mailing address

5750 GRANDSCAPE BLVD APT 11402
THE COLONY TX
75056-6996
US

V. Phone/Fax

Practice location:
  • Phone: 414-323-0260
  • Fax:
Mailing address:
  • Phone: 414-323-0260
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QR0800X
TaxonomyRecovery Care Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. ARNOLDO ANTONIO ALEMAN II
Title or Position: MANAGING MEMBER
Credential:
Phone: 414-550-6002