Provider Demographics
NPI:1548976665
Name:THE CONCRETE ROSE, LLC
Entity type:Organization
Organization Name:THE CONCRETE ROSE, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:DESIREE
Authorized Official - Middle Name:
Authorized Official - Last Name:HUGHES
Authorized Official - Suffix:
Authorized Official - Credentials:MS, MSW, LICSW/LCSW
Authorized Official - Phone:304-712-7374
Mailing Address - Street 1:PO BOX 821
Mailing Address - Street 2:
Mailing Address - City:OAK HILL
Mailing Address - State:WV
Mailing Address - Zip Code:25901-0821
Mailing Address - Country:US
Mailing Address - Phone:304-712-7374
Mailing Address - Fax:
Practice Address - Street 1:110 MAIN ST
Practice Address - Street 2:
Practice Address - City:BECKLEY
Practice Address - State:WV
Practice Address - Zip Code:25801-4611
Practice Address - Country:US
Practice Address - Phone:304-553-0756
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-24
Last Update Date:2023-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty