Provider Demographics
NPI:1467486845
Name:CONCORD NURSING HOME
Entity Type:Organization
Organization Name:CONCORD NURSING HOME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:LILLIE
Authorized Official - Middle Name:
Authorized Official - Last Name:BRYANT-HOBBS
Authorized Official - Suffix:
Authorized Official - Credentials:LNHA
Authorized Official - Phone:718-636-7500
Mailing Address - Street 1:300 MADISON STREET
Mailing Address - Street 2:CONCORD NURSING AND REHABILITATION CENTER
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11216
Mailing Address - Country:US
Mailing Address - Phone:718-636-7500
Mailing Address - Fax:
Practice Address - Street 1:300 MADISON STREET
Practice Address - Street 2:CONCORD NURSING AND REHABILITATION CENTER
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11216
Practice Address - Country:US
Practice Address - Phone:718-636-7500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY7001348N314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY7001348NOtherOPERATING CERTIFICATE
NY335538Medicare ID - Type UnspecifiedFISCAL INTERMEDIARY
NY7001348NOtherOPERATING CERTIFICATE