Provider Demographics
NPI:1669474847
Name:CONCORDIA VISITING NURSES
Entity Type:Organization
Organization Name:CONCORDIA VISITING NURSES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF HOME AND COMMUNITY SERV
Authorized Official - Prefix:MR
Authorized Official - First Name:MARTIN
Authorized Official - Middle Name:J
Authorized Official - Last Name:TRETTEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:724-352-6200
Mailing Address - Street 1:613 N PIKE RD
Mailing Address - Street 2:
Mailing Address - City:CABOT
Mailing Address - State:PA
Mailing Address - Zip Code:16023-2215
Mailing Address - Country:US
Mailing Address - Phone:724-352-6200
Mailing Address - Fax:724-352-3884
Practice Address - Street 1:613 N PIKE ROAD
Practice Address - Street 2:
Practice Address - City:CABOT
Practice Address - State:PA
Practice Address - Zip Code:16023-2215
Practice Address - Country:US
Practice Address - Phone:724-352-6200
Practice Address - Fax:724-352-3884
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-01
Last Update Date:2021-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA397717251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1016716570001Medicaid
PA1016716570001Medicaid