Provider Demographics
NPI:1962107979
Name:CONCERTED CARE GROUP FREDERICKSBURG LLC
Entity type:Organization
Organization Name:CONCERTED CARE GROUP FREDERICKSBURG LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP OF REVENUE CYCLE MANAGEMENT
Authorized Official - Prefix:
Authorized Official - First Name:KEONNA
Authorized Official - Middle Name:
Authorized Official - Last Name:ARMSTRONG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:240-813-9867
Mailing Address - Street 1:3905 NATIONAL DR STE 200
Mailing Address - Street 2:
Mailing Address - City:BURTONSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20866-6143
Mailing Address - Country:US
Mailing Address - Phone:240-813-9867
Mailing Address - Fax:
Practice Address - Street 1:282 DEACON RD STE 107
Practice Address - Street 2:
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22405-2113
Practice Address - Country:US
Practice Address - Phone:240-813-9867
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CCG HOLDCO LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-03-31
Last Update Date:2024-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder