Provider Demographics
NPI:1043441199
Name:CONCORDIA NURSING HOME INC
Entity Type:Organization
Organization Name:CONCORDIA NURSING HOME INC
Other - Org Name:TENSAS HEALTHCARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:MRS
Authorized Official - First Name:TINA
Authorized Official - Middle Name:LOUISE
Authorized Official - Last Name:ELLIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:601-304-0980
Mailing Address - Street 1:901 VERONA STREET
Mailing Address - Street 2:
Mailing Address - City:NEWELLTON
Mailing Address - State:LA
Mailing Address - Zip Code:71357
Mailing Address - Country:US
Mailing Address - Phone:318-467-5117
Mailing Address - Fax:318-467-9716
Practice Address - Street 1:323 HIGHLAND BLVD
Practice Address - Street 2:
Practice Address - City:NATCHEZ
Practice Address - State:MS
Practice Address - Zip Code:39120-4635
Practice Address - Country:US
Practice Address - Phone:601-304-0980
Practice Address - Fax:601-304-1155
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-06
Last Update Date:2009-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA302314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1517976Medicaid
LA1517976Medicaid