MEDICARE: CONCORDIA CARE

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	251T00000X	PACE Provider Organization	2022886	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1700940657
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CONCORDIA CARE

Provider Business Mailing Address
First Line	:	2373 EUCLID HEIGHTS BLVD
Second Line	:
City	:	CLEVELAND HEIGHTS
State	:	OH
Zip	:	44106-2705
Country	:	US
Telephone Number	:	216-791-3580
Fax Number	:	216-791-3281

Provider Business Practice Location Address
First Line	:	2373 EUCLID HEIGHTS BLVD
Second Line	:
City	:	CLEVELAND HEIGHTS
State	:	OH
Zip	:	44106-2705
Country	:	US
Telephone Number	:	216-791-3580
Fax Number	:	216-791-3281

Authorized Official
Title or Position	:	PRESIDENT CEO
Name	:	MS. JANIS FAEHNRICH
Credential	:
Telephone Number	:	216-791-3580

Provider Enumeration Date	:	12/21/2006
Last Update Date	:	08/22/2020

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Directions to “CONCORDIA CARE ” Practice Location

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