Provider Demographics
NPI:1831640390
Name:CONCORDIA OF OHIO
Entity Type:Organization
Organization Name:CONCORDIA OF OHIO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:CHARLENE
Authorized Official - Middle Name:
Authorized Official - Last Name:KISH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:330-664-1360
Mailing Address - Street 1:970 SUMNER PKWY
Mailing Address - Street 2:
Mailing Address - City:COPLEY
Mailing Address - State:OH
Mailing Address - Zip Code:44321-1693
Mailing Address - Country:US
Mailing Address - Phone:330-664-1000
Mailing Address - Fax:330-664-1197
Practice Address - Street 1:970 SUMNER PKWY
Practice Address - Street 2:
Practice Address - City:COPLEY
Practice Address - State:OH
Practice Address - Zip Code:44321-1693
Practice Address - Country:US
Practice Address - Phone:330-664-1000
Practice Address - Fax:330-664-1197
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-20
Last Update Date:2017-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation