Provider Demographics
NPI:1689000333
Name:CONCORDIA TELECAREGIVERS DBA CONCORDIA PRIVATE CARE
Entity Type:Organization
Organization Name:CONCORDIA TELECAREGIVERS DBA CONCORDIA PRIVATE CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
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:MBA
Authorized Official - Phone:724-352-2883
Mailing Address - Street 1:613 N PIKE RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:CABOT
Mailing Address - State:PA
Mailing Address - Zip Code:16023-2215
Mailing Address - Country:US
Mailing Address - Phone:724-352-2883
Mailing Address - Fax:
Practice Address - Street 1:613 N PIKE RD
Practice Address - Street 2:SUITE A
Practice Address - City:CABOT
Practice Address - State:PA
Practice Address - Zip Code:16023-2215
Practice Address - Country:US
Practice Address - Phone:724-352-2883
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-25
Last Update Date:2015-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care