Provider Demographics
NPI:1104239201
Name:CONCORDIA LUTHERAN HEALTH AND HUMAN CARE
Entity type:Organization
Organization Name:CONCORDIA LUTHERAN HEALTH AND HUMAN CARE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:HORTERT
Authorized Official - Suffix:
Authorized Official - Credentials:NHA
Authorized Official - Phone:724-316-9909
Mailing Address - Street 1:4365 NORTHERN PIKE
Mailing Address - Street 2:
Mailing Address - City:MONROEVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:15146-2807
Mailing Address - Country:US
Mailing Address - Phone:412-229-3960
Mailing Address - Fax:412-373-2685
Practice Address - Street 1:4365 NORTHERN PIKE
Practice Address - Street 2:
Practice Address - City:MONROEVILLE
Practice Address - State:PA
Practice Address - Zip Code:15146-2807
Practice Address - Country:US
Practice Address - Phone:412-229-3960
Practice Address - Fax:412-373-2685
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CONCORDIA LUTHERAN HEALTH AND HUMAN CARE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-06-05
Last Update Date:2015-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
No251G00000XAgenciesHospice Care, Community Based
No315D00000XNursing & Custodial Care FacilitiesHospice, Inpatient
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA396138Medicare Oscar/Certification