Provider Demographics
NPI:1154765014
Name:KONCORDA INC
Entity type:Organization
Organization Name:KONCORDA INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:CARMELITE
Authorized Official - Middle Name:
Authorized Official - Last Name:DALMACY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:313-551-9225
Mailing Address - Street 1:99 BURLINGAME ST
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48202-1002
Mailing Address - Country:US
Mailing Address - Phone:313-551-9225
Mailing Address - Fax:
Practice Address - Street 1:99 BURLINGAME ST
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48202-1002
Practice Address - Country:US
Practice Address - Phone:313-551-9225
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-23
Last Update Date:2013-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care