Provider Demographics
NPI:1760262554
Name:CONCORD SENIOR LODGE LLC
Entity Type:Organization
Organization Name:CONCORD SENIOR LODGE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MISS
Authorized Official - First Name:JENNY
Authorized Official - Middle Name:DACASIN
Authorized Official - Last Name:SABAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:925-395-3310
Mailing Address - Street 1:4972 HAMES DR
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:CA
Mailing Address - Zip Code:94521-2247
Mailing Address - Country:US
Mailing Address - Phone:925-827-1678
Mailing Address - Fax:925-849-4982
Practice Address - Street 1:4972 HAMES DR
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:CA
Practice Address - Zip Code:94521-2247
Practice Address - Country:US
Practice Address - Phone:925-827-1678
Practice Address - Fax:925-849-4982
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-29
Last Update Date:2023-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility