NPIMap

Organization Active NPI

Concoh Health Care

  • In Home Supportive Care Agency
  • Stone Mountain, GA
National Provider Identifier
1447662432
Registry record updated May 23, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
In Home Supportive Care AgencyTaxonomy code 253Z00000X
License
044-R-0676 Issued in GA
Legal business name
CONCOH HEALTH CARE
Practice address
5883 Heritage LN
Stone Mountain, GA 30087-1848
Phone
(770) 875-2759
NPI assigned
May 23, 2014
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 23, 2014

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mrs. Nneka Pat EtoNPI 1841155884
Title
Administrator
Phone
(770) 875-2759

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
In Home Supportive Care Agency 253Z00000X 044-R-0676 GA Primary

Addresses

Primary practice location

5883 Heritage LN
Stone Mountain, GA 30087-1848

Mailing address

5883 Heritage LN
Stone Mountain, GA 30087-1848
Phone (770) 875-2759

Other identifiers 1

IdentifierTypeStateIssuer
003131517AMedicaidGA

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1400803200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1400803200000",
    "number": "1447662432",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5883 HERITAGE LN",
            "city": "STONE MOUNTAIN",
            "state": "GA",
            "postal_code": "300871848",
            "telephone_number": "770-875-2759"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5883 HERITAGE LN",
            "city": "STONE MOUNTAIN",
            "state": "GA",
            "postal_code": "300871848",
            "telephone_number": "770-875-2759"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CONCOH HEALTH CARE",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-05-23",
        "last_updated": "2014-05-23",
        "status": "A",
        "authorized_official_last_name": "ETO",
        "authorized_official_first_name": "NNEKA",
        "authorized_official_middle_name": "PAT",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "770-875-2759",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "253Z00000X",
            "taxonomy_group": "",
            "desc": "In Home Supportive Care",
            "state": "GA",
            "license": "044-R-0676",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "003131517A",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Stone Mountain, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 23, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.