- Enrollment id
- O20040727000289
- Enrollment state
- NY
- Provider type code
- 00-18
- Provider type text
- PART A PROVIDER - SKILLED NURSING FACILITY
- Npi
- 1467457002
- Multiple npi flag
- N
- Ccn
- 335493
- Associate id
- 7214830454
- Organization name
- CONCOURSE REHAB & NURSING CTR INC
- Incorporation date
- 1995-08-30
- Incorporation state
- NY
- Organization type structure
- CORPORATION
- Proprietary nonprofit
- P
- Nursing home provider name
- CONCOURSE REHABILITATION AND NURSING CENTER, INC
- Address line 1
- 1072 GRAND CONCOURSE
- City
- BRONX
- State
- NY
- Zip code
- 104563901