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1760262554 NPI number — CONCORD SENIOR LODGE LLC

NPI Number: 1760262554
Health Care Provider/Practitioner: CONCORD SENIOR LODGE LLC

Information about “1760262554” NPI (CONCORD SENIOR LODGE LLC) exists in 1760262554 in HTML format HTML  |  1760262554 in plain Text format TXT  |  1760262554 in PDF (Portable Document Format) PDF  |  1760262554 in an XML format XML  formats.

NPI Number : 1760262554 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1760262554",
    "EntityType": "Organization",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": null,
    "IsOrgSubpart": "N",
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": "CONCORD SENIOR LODGE LLC",
    "LastName": null,
    "FirstName": null,
    "MiddleName": null,
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": null,
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "4972 HAMES DR",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "CONCORD",
    "MailingAddressStateName": "CA",
    "MailingAddressPostalCode": "94521-2247",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "925-827-1678",
    "MailingAddressFaxNumber": "925-849-4982",
    "FirstLinePracticeLocationAddress": "4972 HAMES DR",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "CONCORD",
    "PracticeLocationAddressStateName": "CA",
    "PracticeLocationAddressPostalCode": "94521-2247",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "925-827-1678",
    "PracticeLocationAddressFaxNumber": "925-849-4982",
    "EnumerationDate": "09/29/2023",
    "LastUpdateDate": "09/29/2023",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": null,
    "Gender": null,
    "AuthorizedOfficialLastName": "SABAS",
    "AuthorizedOfficialFirstName": "JENNY",
    "AuthorizedOfficialMiddleName": "DACASIN",
    "AuthorizedOfficialTitle": "ADMINISTRATOR",
    "AuthorizedOfficialNamePrefix": "MISS",
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": "925-395-3310",
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "310400000X",
        "TaxonomyName": "Assisted Living Facility",
        "LicenseNumber": null,
        "LicenseNumberStateCode": null,
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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