Healthcare Provider Details

I. General information

NPI: 1043441199
Provider Name (Legal Business Name): CONCORDIA NURSING HOME INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/06/2009
Last Update Date: 08/06/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

323 HIGHLAND BLVD
NATCHEZ MS
39120-4635
US

IV. Provider business mailing address

901 VERONA STREET
NEWELLTON LA
71357
US

V. Phone/Fax

Practice location:
  • Phone: 601-304-0980
  • Fax: 601-304-1155
Mailing address:
  • Phone: 318-467-5117
  • Fax: 318-467-9716

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number302
License Number StateLA

VIII. Authorized Official

Name: MRS. TINA LOUISE ELLIS
Title or Position: MANAGING MEMBER
Credential:
Phone: 601-304-0980