Provider Demographics
NPI:1144493453
Name:CONCORDIA
Entity type:Organization
Organization Name:CONCORDIA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LEAD ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:JOYCE
Authorized Official - Middle Name:
Authorized Official - Last Name:GOLDIE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:707-255-9555
Mailing Address - Street 1:2435 SUTHERLAND DR
Mailing Address - Street 2:
Mailing Address - City:NAPA
Mailing Address - State:CA
Mailing Address - Zip Code:94558-3153
Mailing Address - Country:US
Mailing Address - Phone:707-255-9555
Mailing Address - Fax:707-255-9577
Practice Address - Street 1:2435 SUTHERLAND DR
Practice Address - Street 2:
Practice Address - City:NAPA
Practice Address - State:CA
Practice Address - Zip Code:94558-3153
Practice Address - Country:US
Practice Address - Phone:707-255-9555
Practice Address - Fax:707-255-9577
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-08
Last Update Date:2008-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA5544854740177F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes177F00000XOther Service ProvidersLodgingGroup - Multi-Specialty