=====================================================
General NPI Number Information
=====================================================
NPI Number | 1477069078
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CONCIERGE HOME CARE, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/18/2017
-----------------------------------------------------
Last Update Date | 12/18/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 761 E GREEN ST STE 6
-----------------------------------------------------
City | PASADENA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91101-2124
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 626-863-7494
-----------------------------------------------------
Fax | 626-657-2905
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 761 E GREEN ST STE 6
-----------------------------------------------------
City | PASADENA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91101-2124
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 626-863-7494
-----------------------------------------------------
Fax | 626-657-2905
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | SAHAK KESHISHYAN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 626-863-7494
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------