Healthcare Provider Details

I. General information

NPI: 1083540959
Provider Name (Legal Business Name): CONCORD SNF OPCO LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/19/2026
Last Update Date: 06/19/2026
Certification Date: 06/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10955 CAPITAL PKWY
CONCORD TOWNSHIP OH
44077-9394
US

IV. Provider business mailing address

6950 US HIGHWAY 9 STE 107
HOWELL NJ
07731-3322
US

V. Phone/Fax

Practice location:
  • Phone: 440-709-1111
  • Fax:
Mailing address:
  • Phone:
  • 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: YECHEZKEL SEREBROWSKI
Title or Position: COO OF THE OPCO
Credential:
Phone: 845-422-3916