Concrete Roses Life Center

Primary specialty

Mental Health Clinic/Center (Including Community Mental Health Center)Taxonomy code 261QM0801X

Legal business name

CONCRETE ROSES LIFE CENTER

Practice address

5960 Fairview Rd Ste 323
Charlotte, NC 28210-3102

Phone

(980) 263-0991

NPI assigned

Mar 21, 2018

Organization subpart

No

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

Authorized official

Name

Shaukura Mandisa Brown

Title

Ceo

Phone

(980) 263-0991

Specialties & licenses 15

Addresses

Medicare fee-for-service enrollment

Enrolled in NC

Enrollment records 1

Locations

Practitioners 4

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

• Courtney S Jones, LCSW

  • Clinical Social Worker
  • Denver, NC
  • NPI 1437401023

  Community/Behavioral Health

  Medicare reassignment NPD
• Lekeshia Miltanette Lynch, LCSW-A

  • Clinical Social Worker
  • Concord, NC
  • NPI 1568899706
  Medicare reassignment NPD
• Anne Wiggins, LCSWA

  • Clinical Social Worker
  • Charlotte, NC
  • NPI 1730424458
  Medicare reassignment NPD
• Delores Estelle Burrill, MSW, LCSW

  • Clinical Social Worker
  • Crofton, MD
  • NPI 1750532461

  NC

  Medicare reassignment NPD

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

{
    "created_epoch": "1521590400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1630540800000",
    "number": "1508360892",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2040 RANDOLPH RD STE A",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282071239",
            "telephone_number": "980-219-8622"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5960 FAIRVIEW RD STE 323",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282103102",
            "telephone_number": "980-263-0991"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CONCRETE ROSES LIFE CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-03-21",
        "last_updated": "2021-09-02",
        "certification_date": "2021-09-02",
        "status": "A",
        "authorized_official_last_name": "BROWN",
        "authorized_official_first_name": "SHAUKURA",
        "authorized_official_middle_name": "MANDISA",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "980-263-0991"
    },
    "taxonomies": [
        {
            "code": "251B00000X",
            "taxonomy_group": "",
            "desc": "Case Management",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "251C00000X",
            "taxonomy_group": "",
            "desc": "Day Training, Developmentally Disabled Services",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "251V00000X",
            "taxonomy_group": "",
            "desc": "Voluntary or Charitable",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QA0600X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adult Day Care",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QD1600X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Developmental Disabilities",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261QM0850X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adult Mental Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QM0855X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adolescent and Children Mental Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QP0904X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Public Health, Federal",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QP0905X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Public Health, State or Local",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QP2000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Physical Therapy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3245S0500X",
            "taxonomy_group": "",
            "desc": "Substance Abuse Rehabilitation Facility, Substance Abuse Treatment, Children",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "385HR2050X",
            "taxonomy_group": "",
            "desc": "Respite Care, Respite Care Camp",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "385HR2060X",
            "taxonomy_group": "",
            "desc": "Respite Care, Respite Care, Intellectual and/or Developmental Disabilities, Child",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Concentra Health Services, Inc.
• Concentra Health Services, Inc.
• Concept of Care Inc
• Concrete Rose Operations LLC
• Concrete Roses Consulting
• Joseph Conde
• Stacy Nicole Conder, PT
• Thomas Frank Condiano, PA
• Freeman James Condon, MD
• Jessica Covington Condon

• Mental Health Clinic/Center (Including Community Mental Health Center) in Charlotte, NC
• Providers in Charlotte, NC by specialty
• Mental Health Clinic/Center (Including Community Mental Health Center) in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 2, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.