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General NPI Number Information
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NPI Number | 1902230105
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Entity Type | Organization
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Legal Business Name | CONCEPT TWO, INC.
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Dates
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Enumeration Date | 08/25/2013
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Last Update Date | 08/25/2013
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Provider Practice Location Address
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Address Line | 4850 65TH ST
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City | VERO BEACH
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State | FL
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Zip | 32967-5364
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Country | US
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Telephone | 772-453-5527
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Fax |
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Provider Business Mailing Address
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Address Line | 1810 46TH AVE
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City | VERO BEACH
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State | FL
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Zip | 32966-2348
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | CHARI L FRY
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Credential |
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Telephone | 772-453-5527
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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 | 6906626
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License Number State | FL
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