Provider Demographics
NPI:1679564900
Name:CONCORD CARE CENTER OF TOLEDO, INC.
Entity type:Organization
Organization Name:CONCORD CARE CENTER OF TOLEDO, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:DEBRA
Authorized Official - Middle Name:A
Authorized Official - Last Name:IFFT
Authorized Official - Suffix:
Authorized Official - Credentials:CPA
Authorized Official - Phone:330-759-2357
Mailing Address - Street 1:3121 GLANZMAN RD
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43614-3802
Mailing Address - Country:US
Mailing Address - Phone:419-385-6616
Mailing Address - Fax:419-389-5101
Practice Address - Street 1:3121 GLANZMAN RD
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43614-3802
Practice Address - Country:US
Practice Address - Phone:419-385-6616
Practice Address - Fax:419-389-5101
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-04
Last Update Date:2007-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH5643314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2109560Medicaid
1740364322OtherMEDICARE DME NPI
OH000000311536OtherANTHEM
OH2109560Medicaid
OH000000311536OtherANTHEM
OH1265930001Medicare NSC