Provider Demographics
NPI:1700940657
Name:CONCORDIA CARE
Entity Type:Organization
Organization Name:CONCORDIA CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:JANIS
Authorized Official - Middle Name:
Authorized Official - Last Name:FAEHNRICH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:216-791-3580
Mailing Address - Street 1:2373 EUCLID HEIGHTS BLVD
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44106-2705
Mailing Address - Country:US
Mailing Address - Phone:216-791-3580
Mailing Address - Fax:216-791-3281
Practice Address - Street 1:2373 EUCLID HEIGHTS BLVD
Practice Address - Street 2:
Practice Address - City:CLEVELAND HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44106-2705
Practice Address - Country:US
Practice Address - Phone:216-791-3580
Practice Address - Fax:216-791-3281
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2022886251T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251T00000XAgenciesProgram of All-Inclusive Care for the Elderly (PACE) Provider Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2022886Medicaid
OH2022886Medicaid