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General NPI Number Information
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NPI Number | 1013908334
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Entity Type | Organization
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Legal Business Name | CONCORD CARE CENTER OF CORTLAND, INC.
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Dates
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Enumeration Date | 11/04/2005
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Last Update Date | 07/12/2007
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Provider Practice Location Address
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Address Line | 4250 SODOM HUTCHINGS RD
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City | CORTLAND
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State | OH
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Zip | 44410-9790
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Country | US
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Telephone | 330-637-7906
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Fax | 330-638-2639
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Provider Business Mailing Address
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Address Line | 4250 SODOM HUTCHINGS RD
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City | CORTLAND
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State | OH
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Zip | 44410-9790
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Country | US
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Telephone | 330-637-7906
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Fax | 330-638-2639
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Authorized Official
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Title or Position | CEO
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Name | MRS. DEBRA A. IFFT
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Credential | CPA
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Telephone | 330-759-2357
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number | 5644
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License Number State | OH
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