Provider Demographics
NPI:1669703955
Name:CONCORD HEALTH AND REHABILITATION,LLC
Entity type:Organization
Organization Name:CONCORD HEALTH AND REHABILITATION,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TODD
Authorized Official - Middle Name:
Authorized Official - Last Name:BOGOS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:856-235-0202
Mailing Address - Street 1:1010 CONCORD AVE
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19802-3367
Mailing Address - Country:US
Mailing Address - Phone:856-235-0202
Mailing Address - Fax:856-235-3377
Practice Address - Street 1:28 N. DUPONT BLVD
Practice Address - Street 2:CONCORD HEALTH AND REHABILITATION
Practice Address - City:SMYRNA
Practice Address - State:DE
Practice Address - Zip Code:19977
Practice Address - Country:US
Practice Address - Phone:302-653-8435
Practice Address - Fax:302-653-8437
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-26
Last Update Date:2010-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEF10000687111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE099013U45Medicare PIN