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General NPI Number Information
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NPI Number | 1760262554
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Entity Type | Organization
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Legal Business Name | CONCORD SENIOR LODGE LLC
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Dates
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Enumeration Date | 09/29/2023
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Last Update Date | 09/29/2023
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Provider Practice Location Address
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Address Line | 4972 HAMES DR
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City | CONCORD
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State | CA
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Zip | 94521-2247
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Country | US
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Telephone | 925-827-1678
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Fax | 925-849-4982
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Provider Business Mailing Address
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Address Line | 4972 HAMES DR
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City | CONCORD
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State | CA
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Zip | 94521-2247
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Country | US
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Telephone | 925-827-1678
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Fax | 925-849-4982
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MISS JENNY DACASIN SABAS
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Credential |
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Telephone | 925-395-3310
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number |
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License Number State |
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