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General NPI Number Information
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NPI Number | 1043441199
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Entity Type | Organization
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Legal Business Name | CONCORDIA NURSING HOME INC
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Dates
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Enumeration Date | 08/06/2009
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Last Update Date | 08/06/2009
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Provider Practice Location Address
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Address Line | 323 HIGHLAND BLVD
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City | NATCHEZ
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State | MS
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Zip | 39120-4635
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Country | US
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Telephone | 601-304-0980
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Fax | 601-304-1155
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Provider Business Mailing Address
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Address Line | 901 VERONA STREET
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City | NEWELLTON
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State | LA
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Zip | 71357
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Country | US
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Telephone | 318-467-5117
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Fax | 318-467-9716
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Authorized Official
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Title or Position | MANAGING MEMBER
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Name | MRS. TINA LOUISE ELLIS
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Credential |
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Telephone | 601-304-0980
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number | 302
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License Number State | LA
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