Healthcare Provider Details

I. General information

NPI: 1952140253
Provider Name (Legal Business Name): CONCIERGE COMPASSIONATE CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/24/2024
Last Update Date: 05/24/2024
Certification Date: 05/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1801 SWAN ST
LONGVIEW TX
75604-2451
US

IV. Provider business mailing address

1801 SWAN ST
LONGVIEW TX
75604-2451
US

V. Phone/Fax

Practice location:
  • Phone: 903-240-0957
  • Fax:
Mailing address:
  • Phone: 903-240-0957
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number State

VIII. Authorized Official

Name: MS. JESSICA GARLAND
Title or Position: AMBR
Credential:
Phone: 903-240-0957