Healthcare Provider Details

I. General information

NPI: 1831640390
Provider Name (Legal Business Name): CONCORDIA OF OHIO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/20/2016
Last Update Date: 03/03/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

970 SUMNER PKWY
COPLEY OH
44321-1693
US

IV. Provider business mailing address

970 SUMNER PKWY
COPLEY OH
44321-1693
US

V. Phone/Fax

Practice location:
  • Phone: 330-664-1000
  • Fax: 330-664-1197
Mailing address:
  • Phone: 330-664-1000
  • Fax: 330-664-1197

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0400X
TaxonomyRehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: CHARLENE KISH
Title or Position: CEO
Credential:
Phone: 330-664-1360