Avante at Concord, Inc.

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

NH0179 Issued in NC

Legal business name

AVANTE AT CONCORD, INC.

Practice address

515 Lake Concord Rd NE
Concord, NC 28025-2925

Phone

(704) 784-4494

Fax

(704) 784-9669

NPI assigned

Oct 26, 2006

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Dean J Dickmann

Title

President

Phone

(985) 987-7180

Specialties & licenses 2

Addresses

Other identifiers 2

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1161820800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1212451200000",
    "number": "1174608194",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4000 HOLLYWOOD BLVD",
            "address_2": "SUITE 540 NORTH",
            "city": "HOLLYWOOD",
            "state": "FL",
            "postal_code": "330216751",
            "telephone_number": "954-987-7180",
            "fax_number": "954-989-5287"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "515 LAKE CONCORD RD NE",
            "city": "CONCORD",
            "state": "NC",
            "postal_code": "280252925",
            "telephone_number": "704-784-4494",
            "fax_number": "704-784-9669"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AVANTE AT CONCORD, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-26",
        "last_updated": "2008-06-03",
        "status": "A",
        "authorized_official_last_name": "DICKMANN",
        "authorized_official_first_name": "DEAN",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "985-987-7180",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "313M00000X",
            "taxonomy_group": "",
            "desc": "Nursing Facility/Intermediate Care Facility",
            "state": "NC",
            "license": "NH0179",
            "primary": false
        },
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "NC",
            "license": "NH0179",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3416003",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3415130",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Skilled Nursing Facility in Concord, NC
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• Skilled Nursing Facility in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 3, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.