Provider Demographics
NPI:1487705273
Name:CONCIERGE PARK LP
Entity type:Organization
Organization Name:CONCIERGE PARK LP
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:
Authorized Official - Last Name:EHMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-558-3900
Mailing Address - Street 1:2310 ELDRIDGE PKWY S
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77077-5254
Mailing Address - Country:US
Mailing Address - Phone:281-558-3900
Mailing Address - Fax:281-558-4434
Practice Address - Street 1:2310 ELDRIDGE PKWY S
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77077-5254
Practice Address - Country:US
Practice Address - Phone:281-558-3900
Practice Address - Fax:281-558-4434
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-16
Last Update Date:2021-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX118590314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX001015531Medicaid