MEDICARE: CONCIERGE SENIOR CARE MANAGEMENT SERVICES

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	253Z00000X	In Home Supportive Care Agency

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	304700308	OTHER	CA	CALIFORNIA DEPARTMENT OF SOCIAL SERVICES

General Provider Information

NPI Number	:	1710633292
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CONCIERGE SENIOR CARE MANAGEMENT SERVICES

Provider Business Mailing Address
First Line	:	4029 WESTERLY PL STE 110
Second Line	:
City	:	NEWPORT BEACH
State	:	CA
Zip	:	92660-2329
Country	:	US
Telephone Number	:	949-569-9100
Fax Number	:

Provider Business Practice Location Address
First Line	:	4029 WESTERLY PL STE 110
Second Line	:
City	:	NEWPORT BEACH
State	:	CA
Zip	:	92660-2329
Country	:	US
Telephone Number	:	949-569-9100
Fax Number	:

Authorized Official
Title or Position	:	OWNER/CEO
Name	:	CHRISTINE LOTTMAN
Credential	:	RN
Telephone Number	:	949-569-9100

Provider Enumeration Date	:	02/23/2022
Last Update Date	:	03/22/2022

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