Provider Demographics
NPI:1801888292
Name:CONCORDIA OF MONROEVILLE
Entity type:Organization
Organization Name:CONCORDIA OF MONROEVILLE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:K
Authorized Official - Last Name:HORTERT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:724-316-9909
Mailing Address - Street 1:4363 NORTHERN PIKE
Mailing Address - Street 2:
Mailing Address - City:MONROEVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:15146-2807
Mailing Address - Country:US
Mailing Address - Phone:412-373-3900
Mailing Address - Fax:412-373-5600
Practice Address - Street 1:4363 NORTHERN PIKE
Practice Address - Street 2:
Practice Address - City:MONROEVILLE
Practice Address - State:PA
Practice Address - Zip Code:15146-2807
Practice Address - Country:US
Practice Address - Phone:412-373-3900
Practice Address - Fax:412-373-5600
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CONCORDIA LUTHERAN MINISTRIES OF PITTSBURGH
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-08-22
Last Update Date:2014-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA310400000X
PA77570501314000000X
PA062502314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
No310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1249OtherHIGHMARK BLUE CROSS
PA0017213800001Medicaid
PA396059Medicare Oscar/Certification