Healthcare Provider Details

I. General information

NPI: 1962107979
Provider Name (Legal Business Name): CONCERTED CARE GROUP FREDERICKSBURG LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/31/2023
Last Update Date: 08/20/2024
Certification Date: 08/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

282 DEACON RD STE 107
FREDERICKSBURG VA
22405-2113
US

IV. Provider business mailing address

3905 NATIONAL DR STE 200
BURTONSVILLE MD
20866-6143
US

V. Phone/Fax

Practice location:
  • Phone: 240-813-9867
  • Fax:
Mailing address:
  • Phone: 240-813-9867
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: KEONNA ARMSTRONG
Title or Position: VP OF REVENUE CYCLE MANAGEMENT
Credential:
Phone: 240-813-9867