Provider Demographics
NPI:1306445754
Name:CONCIERGE REHAB INC
Entity type:Organization
Organization Name:CONCIERGE REHAB INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:PHILIPPE
Authorized Official - Middle Name:
Authorized Official - Last Name:RENAUD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:508-517-3813
Mailing Address - Street 1:1045 E HERITAGE CLUB CIR
Mailing Address - Street 2:
Mailing Address - City:DELRAY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33483-3483
Mailing Address - Country:US
Mailing Address - Phone:508-517-3813
Mailing Address - Fax:
Practice Address - Street 1:1045 E HERITAGE CLUB CIR
Practice Address - Street 2:
Practice Address - City:DELRAY BEACH
Practice Address - State:FL
Practice Address - Zip Code:33483-3483
Practice Address - Country:US
Practice Address - Phone:508-517-3813
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-17
Last Update Date:2020-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1053872374Medicaid