Provider Demographics
NPI:1275784696
Name:CONCORDIA HEALTH CARE PROVIDER INC.
Entity Type:Organization
Organization Name:CONCORDIA HEALTH CARE PROVIDER INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:ROSITA
Authorized Official - Middle Name:A
Authorized Official - Last Name:BALAO
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:626-281-7400
Mailing Address - Street 1:2225 W COMMONWEALTH AVE STE 305
Mailing Address - Street 2:
Mailing Address - City:ALHAMBRA
Mailing Address - State:CA
Mailing Address - Zip Code:91803-1335
Mailing Address - Country:US
Mailing Address - Phone:626-281-7400
Mailing Address - Fax:626-281-7401
Practice Address - Street 1:2225 W. COMMONWEALTH AVE.,
Practice Address - Street 2:SUITE 305
Practice Address - City:ALHAMBRA
Practice Address - State:CA
Practice Address - Zip Code:91803-1335
Practice Address - Country:US
Practice Address - Phone:626-281-7400
Practice Address - Fax:626-281-7401
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-03
Last Update Date:2012-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA059327Medicare Oscar/Certification