MEDICARE: CONCORD HOME HEALTH CARE

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
1	251E00000X	Home Health Agency	11432906	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	058215	OTHER	CA	TO SERVICE MANAGED CARE PATIENTS THAT HAVE OON BENIFITS

General Provider Information

NPI Number	:	1588191274
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CONCORD HOME HEALTH CARE

Provider Business Mailing Address
First Line	:	6824 RADFORD AVE
Second Line	:	SUITE 1
City	:	NORTH HOLLYWOOD
State	:	CA
Zip	:	91605
Country	:	US
Telephone Number	:	818-209-1919
Fax Number	:

Provider Business Practice Location Address
First Line	:	6824 RADFORD AVE
Second Line	:	SUITE 1
City	:	NORTH HOLLYWOOD
State	:	CA
Zip	:	91605
Country	:	US
Telephone Number	:	818-209-1919
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	MARUT ANTONIAN
Credential	:
Telephone Number	:	818-209-1919

Provider Enumeration Date	:	05/12/2017
Last Update Date	:	05/12/2017

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Directions to “CONCORD HOME HEALTH CARE ” Practice Location

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