Basic Information
Provider Information
NPI: 1467486845
EntityType: 2
ReplacementNPI:  
OrganizationName: CONCORD NURSING HOME
LastName:  
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Mailing Information
Address1: 300 MADISON STREET
Address2: CONCORD NURSING AND REHABILITATION CENTER
City: BROOKLYN
State: NY
PostalCode: 11216
CountryCode: US
TelephoneNumber: 7186367500
FaxNumber:  
Practice Location
Address1: 300 MADISON STREET
Address2: CONCORD NURSING AND REHABILITATION CENTER
City: BROOKLYN
State: NY
PostalCode: 11216
CountryCode: US
TelephoneNumber: 7186367500
FaxNumber:  
Other Information
ProviderEnumerationDate: 07/10/2006
LastUpdateDate: 08/22/2020
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode:  
AuthorizedOfficialLastName: BRYANT-HOBBS
AuthorizedOfficialFirstName: LILLIE
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition: ADMINISTRATOR
AuthorizedOfficialTelephone: 7186367500
IsSoleProprietor:  
IsOrganizationSubpart: N
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix: MS.
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential: LNHA
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
314000000X7001348NNYY Nursing & Custodial Care FacilitiesSkilled Nursing Facility 

ID Information
IDTypeStateIssuerDescription
7001348N01NYOPERATING CERTIFICATEOTHER


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