Provider Demographics
NPI:1952594111
Name:CONCORDIA VISITING NURSES
Entity Type:Organization
Organization Name:CONCORDIA VISITING NURSES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MARTIN
Authorized Official - Middle Name:J
Authorized Official - Last Name:TRETTEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:724-352-6200
Mailing Address - Street 1:16687 SAINT CLAIR AVE
Mailing Address - Street 2:SUITE 202
Mailing Address - City:EAST LIVERPOOL
Mailing Address - State:OH
Mailing Address - Zip Code:43920-9401
Mailing Address - Country:US
Mailing Address - Phone:330-386-7700
Mailing Address - Fax:330-386-7702
Practice Address - Street 1:16687 SAINT CLAIR AVE
Practice Address - Street 2:SUITE 202
Practice Address - City:EAST LIVERPOOL
Practice Address - State:OH
Practice Address - Zip Code:43920-9401
Practice Address - Country:US
Practice Address - Phone:330-386-7700
Practice Address - Fax:330-386-7702
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-21
Last Update Date:2014-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH36-8237Medicare PIN
OH36-8237Medicare PIN