Provider Demographics
NPI:1497831606
Name:CONCORD CARE CENTER OF HARTFORD INC.
Entity Type:Organization
Organization Name:CONCORD CARE CENTER OF HARTFORD INC.
Other - Org Name:MEADOWBROOK MANOR
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:DEBRA
Authorized Official - Middle Name:A
Authorized Official - Last Name:IFFT
Authorized Official - Suffix:
Authorized Official - Credentials:CPA
Authorized Official - Phone:330-759-2357
Mailing Address - Street 1:3090 FIVE POINTS HARTFORD RD
Mailing Address - Street 2:
Mailing Address - City:FOWLER
Mailing Address - State:OH
Mailing Address - Zip Code:44418-9726
Mailing Address - Country:US
Mailing Address - Phone:330-772-5253
Mailing Address - Fax:330-772-7771
Practice Address - Street 1:3090 FIVE POINTS HARTFORD RD
Practice Address - Street 2:
Practice Address - City:FOWLER
Practice Address - State:OH
Practice Address - Zip Code:44418-9726
Practice Address - Country:US
Practice Address - Phone:330-772-5253
Practice Address - Fax:330-772-7771
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CONCORD CARE CENTER OF HARTFORD INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-10-31
Last Update Date:2007-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH5645332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH1265330001Medicare NSC