Provider Demographics
NPI:1982860375
Name:CONCORDIA LUTHERAN HEALTH AND HUMAN CARE
Entity Type:Organization
Organization Name:CONCORDIA LUTHERAN HEALTH AND HUMAN CARE
Other - Org Name:CONCORDIA OUTPATIENT THERAPY
Other - Org Type:Other Name
Authorized Official - Title/Position:VICE PRESIDENT OF SKILLED NURSING
Authorized Official - Prefix:MRS
Authorized Official - First Name:CHARLENE
Authorized Official - Middle Name:
Authorized Official - Last Name:KISH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:724-352-1571
Mailing Address - Street 1:134 MARWOOD RD
Mailing Address - Street 2:
Mailing Address - City:CABOT
Mailing Address - State:PA
Mailing Address - Zip Code:16023-2206
Mailing Address - Country:US
Mailing Address - Phone:724-352-1571
Mailing Address - Fax:724-352-2740
Practice Address - Street 1:134 MARWOOD RD
Practice Address - Street 2:
Practice Address - City:CABOT
Practice Address - State:PA
Practice Address - Zip Code:16023-2206
Practice Address - Country:US
Practice Address - Phone:724-352-1571
Practice Address - Fax:724-352-2740
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CONCORDIA LUTHERAN MINISTRIES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-08-05
Last Update Date:2016-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA396756Medicare Oscar/Certification