Provider Demographics
NPI:1356982615
Name:CONCILDA SERVICE COORDINATION LLC
Entity type:Organization
Organization Name:CONCILDA SERVICE COORDINATION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/ PROGRAM DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:GILLIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:SLOCUM-ROSS
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:484-433-1963
Mailing Address - Street 1:527 N CHARLOTTE ST
Mailing Address - Street 2:
Mailing Address - City:POTTSTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19464-4602
Mailing Address - Country:US
Mailing Address - Phone:484-433-1963
Mailing Address - Fax:
Practice Address - Street 1:527 N CHARLOTTE ST
Practice Address - Street 2:
Practice Address - City:POTTSTOWN
Practice Address - State:PA
Practice Address - Zip Code:19464-4602
Practice Address - Country:US
Practice Address - Phone:484-433-1963
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-07
Last Update Date:2019-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management