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General NPI Number Information
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NPI Number | 1063634731
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Entity Type | Organization
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Legal Business Name | CONCORDE LOVING CARE, INC.
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Dates
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Enumeration Date | 05/03/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 13 POPE LANE
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City | PALM COAST
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State | FL
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Zip | 32164
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Country | US
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Telephone | 386-437-1373
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Fax | 386-437-1703
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Provider Business Mailing Address
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Address Line | 6 RYLEY LANE
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City | PALM COAST
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State | FL
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Zip | 32164
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Country | US
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Telephone | 386-437-1373
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Fax | 386-586-6095
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MRS. IDA M. HARRIS
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Credential |
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Telephone | 386-437-1373
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number | AL9003
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number | AL9204
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License Number State | FL
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