Healthcare Provider Details

I. General information

NPI: 1497831606
Provider Name (Legal Business Name): CONCORD CARE CENTER OF HARTFORD INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/31/2006
Last Update Date: 07/12/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3090 FIVE POINTS HARTFORD RD
FOWLER OH
44418-9726
US

IV. Provider business mailing address

3090 FIVE POINTS HARTFORD RD
FOWLER OH
44418-9726
US

V. Phone/Fax

Practice location:
  • Phone: 330-772-5253
  • Fax: 330-772-7771
Mailing address:
  • Phone: 330-772-5253
  • Fax: 330-772-7771

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number5645
License Number StateOH

VIII. Authorized Official

Name: MRS. DEBRA A IFFT
Title or Position: CEO
Credential: CPA
Phone: 330-759-2357