Healthcare Provider Details

I. General information

NPI: 1619004827
Provider Name (Legal Business Name): CONCORD NURSING HOME, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/27/2007
Last Update Date: 10/05/2021
Certification Date: 10/05/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 MADISON ST
BROOKLYN NY
11216-1509
US

IV. Provider business mailing address

4770 WHITE PLAINS RD
BRONX NY
10470-1104
US

V. Phone/Fax

Practice location:
  • Phone: 718-636-7500
  • Fax: 718-636-7518
Mailing address:
  • Phone: 718-931-9700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

Name: EITAN NAT
Title or Position: ADMINISTRATOR
Credential: LNHA
Phone: 718-636-7500