MEDICARE: CONCORDIA VISITING NURSES

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251E00000X	Home Health Agency		OH

General Provider Information

NPI Number	:	1952594111
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CONCORDIA VISITING NURSES

Provider Business Mailing Address
First Line	:	16687 SAINT CLAIR AVE
Second Line	:	SUITE 202
City	:	EAST LIVERPOOL
State	:	OH
Zip	:	43920-9401
Country	:	US
Telephone Number	:	330-386-7700
Fax Number	:	330-386-7702

Provider Business Practice Location Address
First Line	:	16687 SAINT CLAIR AVE
Second Line	:	SUITE 202
City	:	EAST LIVERPOOL
State	:	OH
Zip	:	43920-9401
Country	:	US
Telephone Number	:	330-386-7700
Fax Number	:	330-386-7702

Authorized Official
Title or Position	:	DIRECTOR
Name	:	MARTIN J TRETTEL
Credential	:
Telephone Number	:	724-352-6200

Provider Enumeration Date	:	08/21/2007
Last Update Date	:	03/24/2014

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Directions to “CONCORDIA VISITING NURSES ” Practice Location

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