Provider Demographics
NPI:1194716944
Name:CONCORDIA LUTHERAN MINISTRIES OF PITTSBURGH
Entity type:Organization
Organization Name:CONCORDIA LUTHERAN MINISTRIES OF PITTSBURGH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:KAY
Authorized Official - Middle Name:
Authorized Official - Last Name:FRNDAK-SUDER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:724-272-6812
Mailing Address - Street 1:1300 BOWER HILL ROAD
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15243-1388
Mailing Address - Country:US
Mailing Address - Phone:412-278-1300
Mailing Address - Fax:412-279-4719
Practice Address - Street 1:1300 BOWER HILL ROAD
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15243-1388
Practice Address - Country:US
Practice Address - Phone:412-278-1300
Practice Address - Fax:412-279-4719
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CONCORDIA LUTHERAN MINISTRIES OF PITTSBURGH
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-11-01
Last Update Date:2018-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA002670310400000X
PA14790201314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
No310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA396089Medicare PIN