Provider Demographics
NPI:1013908359
Name:CONCORD CARE CENTER OF MILAN, INC.
Entity Type:Organization
Organization Name:CONCORD CARE CENTER OF MILAN, INC.
Other - Org Name:BRIARFIELD OF MILAN
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 1:185 S MAIN ST
Mailing Address - Street 2:P.O. BOX 1650
Mailing Address - City:MILAN
Mailing Address - State:OH
Mailing Address - Zip Code:44846-9765
Mailing Address - Country:US
Mailing Address - Phone:419-499-2576
Mailing Address - Fax:419-499-4577
Practice Address - Street 1:185 S MAIN ST
Practice Address - Street 2:
Practice Address - City:MILAN
Practice Address - State:OH
Practice Address - Zip Code:44846-9765
Practice Address - Country:US
Practice Address - Phone:419-499-2576
Practice Address - Fax:419-499-4577
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-04
Last Update Date:2007-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH5359313M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2052095Medicaid
OH000000314543OtherANTHEM
366067Medicare PIN
OH366067Medicare ID - Type UnspecifiedPROVIDER NUMBER
OH000000314543OtherANTHEM