Eagle Acquisition I LLC

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

Legal business name

EAGLE ACQUISITION I LLC

Doing business as

Concordia Nursing and Rehabilitation Center - Lafayette

Practice address

110 Brandywine Blvd
Fayetteville, GA 30214-1500

Phone

(770) 461-2928

Fax

(770) 461-8507

NPI assigned

Aug 3, 2017

Organization subpart

No

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

Authorized official

Name

Bent Philipson

Title

Managing Member

Phone

(516) 869-3700

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Concordia Nursing and Rehabilitation Center - Lafayette Doing business as

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

{
    "created_epoch": "1501718400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658361600000",
    "number": "1265956965",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "110 BRANDYWINE BLVD",
            "city": "FAYETTEVILLE",
            "state": "GA",
            "postal_code": "302141500",
            "telephone_number": "770-461-2928",
            "fax_number": "770-461-8507"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "110 BRANDYWINE BLVD",
            "city": "FAYETTEVILLE",
            "state": "GA",
            "postal_code": "302141500",
            "telephone_number": "770-461-2928",
            "fax_number": "770-461-8507"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EAGLE ACQUISITION I LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-08-03",
        "last_updated": "2022-07-21",
        "status": "A",
        "authorized_official_last_name": "PHILIPSON",
        "authorized_official_first_name": "BENT",
        "authorized_official_title_or_position": "MANAGING MEMBER",
        "authorized_official_telephone_number": "516-869-3700"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00399737A",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Concordia Nursing and Rehabilitation Center - Lafayette",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Fernando A. Duralde, M.D.
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• Kristie Yancy Dyson, MD
• E Medical Transportation Services LLC
• Eaglin Dental Group, Fayetteville
• Maria Magdalena Earnhart
• Easy Walk Foot Clinic LLC
• Eca Optical, LLC
• Alexa Nicole Echevarria, BA, RBT

• Skilled Nursing Facility in Fayetteville, GA
• Providers in Fayetteville, GA by specialty
• Skilled Nursing Facility in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; 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.