Healthcare Provider Details

I. General information

NPI: 1013908359
Provider Name (Legal Business Name): CONCORD CARE CENTER OF MILAN, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/04/2005
Last Update Date: 07/12/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

185 S MAIN ST
MILAN OH
44846-9765
US

IV. Provider business mailing address

185 S MAIN ST P.O. BOX 1650
MILAN OH
44846-9765
US

V. Phone/Fax

Practice location:
  • Phone: 419-499-2576
  • Fax: 419-499-4577
Mailing address:
  • Phone: 419-499-2576
  • Fax: 419-499-4577

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code313M00000X
TaxonomyNursing Facility/Intermediate Care Facility
License Number5359
License Number StateOH

VIII. Authorized Official

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