Provider Demographics
NPI:1407240419
Name:CONCORDIA HEALTH CARE INC
Entity Type:Organization
Organization Name:CONCORDIA HEALTH CARE INC
Other - Org Name:CONCORDIA CARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT & CEO
Authorized Official - Prefix:
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:LOUISE
Authorized Official - Last Name:TAYLOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-221-9137
Mailing Address - Street 1:2520 S 5TH AVE
Mailing Address - Street 2:
Mailing Address - City:POCATELLO
Mailing Address - State:ID
Mailing Address - Zip Code:83204-1923
Mailing Address - Country:US
Mailing Address - Phone:208-221-9137
Mailing Address - Fax:888-222-6504
Practice Address - Street 1:1200 HOSPITAL WAY
Practice Address - Street 2:
Practice Address - City:POCATELLO
Practice Address - State:ID
Practice Address - Zip Code:83201-2708
Practice Address - Country:US
Practice Address - Phone:208-232-2570
Practice Address - Fax:208-233-6769
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-27
Last Update Date:2015-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID37314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID135071Medicare Oscar/Certification