MEDICARE: CONCORD HOME CARE, 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
1	163WH0200X	Home Health Registered Nurse

General Provider Information

NPI Number	:	1942083472
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CONCORD HOME CARE, LLC

Provider Business Mailing Address
First Line	:	1211 TECH BLVD STE 110
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33619-7846
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1211 TECH BLVD STE 110
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33619-7846
Country	:	US
Telephone Number	:	813-490-5907
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	SHAYNA CADET
Credential	:	RN
Telephone Number	:	239-822-0823

Provider Enumeration Date	:	08/17/2023
Last Update Date	:	12/15/2023

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