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NPI Code Detail

MEDICARE: CONCORDE TREATMENT CENTER,LLC

MEDICARE: CONCORDE TREATMENT CENTER,LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
13336I0012XInstitutional PharmacyIA02919NV

General Provider Information

NPI Number : 1326482456
Entity Type Code : Organization
Provider Name (Legal Business Name) : CONCORDE TREATMENT CENTER,LLC
Provider Business Mailing Address
First Line : 200 POWELL PL
Second Line : ATTN: LEGAL DEPARTMENT
City : BRENTWOOD
State : TN
Zip : 37027-7514
Country : US
Telephone Number : 615-732-1605
Fax Number :
Provider Business Practice Location Address
First Line : 2465 E TWAIN AVE
Second Line :
City : LAS VEGAS
State : NV
Zip : 89121-4011
Country : US
Telephone Number : 702-789-6207
Fax Number : 702-789-6197
Authorized Official
Title or Position : FACILITY CEO
Name : DEREK PRICE
Credential :
Telephone Number : 702-789-6242
Provider Enumeration Date : 04/19/2013
Last Update Date : 08/25/2021

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