Organization
EAGLE ACQUISITION I LLC
Active
Other names
Concordia Nursing and Rehabilitation Center - Lafayette
Organization subpart
No
Provider details
NPI number
Authorized official
BENT PHILIPSON (MANAGING MEMBER)
(516) 869-3700
Entity
Organization
Contact information
Practice address
110 BRANDYWINE BLVD, FAYETTEVILLE, GA 30214-1500
(770) 461-2928
(770) 461-8507
Mailing address
110 BRANDYWINE BLVD, FAYETTEVILLE, GA 30214-1500
(770) 461-2928
(770) 461-8507
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00399737A
—
GA
Enumeration date
08/03/2017
Last updated
07/21/2022
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