Provider Demographics
NPI:1619004827
Name:CONCORD NURSING HOME, INC.
Entity Type:Organization
Organization Name:CONCORD NURSING HOME, INC.
Other - Org Name:CONCORD NURSING AND REHABILITATION CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:EITAN
Authorized Official - Middle Name:
Authorized Official - Last Name:NAT
Authorized Official - Suffix:
Authorized Official - Credentials:LNHA
Authorized Official - Phone:718-636-7500
Mailing Address - Street 1:4770 WHITE PLAINS RD
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10470-1104
Mailing Address - Country:US
Mailing Address - Phone:718-931-9700
Mailing Address - Fax:
Practice Address - Street 1:300 MADISON ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11216-1509
Practice Address - Country:US
Practice Address - Phone:718-636-7500
Practice Address - Fax:718-636-7518
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-27
Last Update Date:2021-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00314609Medicaid
NY00314609Medicaid
NY02349306OtherADULT HEALTH DAY CARE