MEDICARE: CHRISTIAN COMPANION SENIOR 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	251E00000X	Home Health Agency	11128	AR

General Provider Information

NPI Number	:	1124383138
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHRISTIAN COMPANION SENIOR CARE

Provider Business Mailing Address
First Line	:	521 S BRYAN AVE
Second Line	:
City	:	NORTH PLATTE
State	:	NE
Zip	:	69101-5604
Country	:	US
Telephone Number	:	308-530-6027
Fax Number	:	877-455-6041

Provider Business Practice Location Address
First Line	:	521 S BRYAN AVE
Second Line	:
City	:	NORTH PLATTE
State	:	NE
Zip	:	69101-5604
Country	:	US
Telephone Number	:	308-530-6027
Fax Number	:	877-455-6041

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	MRS. KERRY SIDES
Credential	:
Telephone Number	:	308-530-6027

Provider Enumeration Date	:	07/06/2012
Last Update Date	:	10/25/2012

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