Provider Demographics
NPI:1508033556
Name:CONCORD NURSING & REHABILITATION CENTER
Entity Type:Organization
Organization Name:CONCORD NURSING & REHABILITATION CENTER
Other - Org Name:CONCORD NURSING HOME
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:LILLIE
Authorized Official - Middle Name:M
Authorized Official - Last Name:BRYANT-HOBBS
Authorized Official - Suffix:
Authorized Official - Credentials:MHS
Authorized Official - Phone:718-636-7500
Mailing Address - Street 1:300 MADISON ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11216-1509
Mailing Address - Country:US
Mailing Address - Phone:718-636-7500
Mailing Address - Fax:718-636-7518
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:2008-05-09
Last Update Date:2008-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY261QA0600X261QA0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02349306Medicaid