Healthcare Provider Details

I. General information

NPI: 1568818177
Provider Name (Legal Business Name): CONCORD WELLNESS CENTER & HOME HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/12/2016
Last Update Date: 06/06/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4126 CLEMSON BLVD SUITE 1A
ANDERSON SC
29621-1113
US

IV. Provider business mailing address

4126 CLEMSON BLVD SUITE 1A
ANDERSON SC
29621-1113
US

V. Phone/Fax

Practice location:
  • Phone: 864-760-1010
  • Fax:
Mailing address:
  • Phone: 864-760-1010
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code302R00000X
TaxonomyHealth Maintenance Organization
License Number19338
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number17933
License Number StateSC

VIII. Authorized Official

Name: NATASHA L RHONE
Title or Position: CEO
Credential: RN
Phone: 864-760-1010