Provider Demographics
NPI:1730767757
Name:CONCIERGE SERVICES
Entity type:Organization
Organization Name:CONCIERGE SERVICES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:BOCHENEK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-964-6000
Mailing Address - Street 1:PO BOX 1105
Mailing Address - Street 2:
Mailing Address - City:ATHOL
Mailing Address - State:ID
Mailing Address - Zip Code:83801-1105
Mailing Address - Country:US
Mailing Address - Phone:208-964-6000
Mailing Address - Fax:
Practice Address - Street 1:24777 N CORBIN HILL RD
Practice Address - Street 2:
Practice Address - City:ATHOL
Practice Address - State:ID
Practice Address - Zip Code:83801-8677
Practice Address - Country:US
Practice Address - Phone:208-964-6000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WUMPUS LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-03-31
Last Update Date:2024-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care AttendantGroup - Multi-Specialty
No3747A0650XNursing Service Related ProvidersTechnicianAttendant Care ProviderGroup - Multi-Specialty