MEDICARE: FIRST CHRISTIAN CHURCH OF HUNTINGTON BEACH

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	282J00000X	Religious Nonmedical Health Care Institution

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	UNKNOWN	OTHER		VARIOUS INSURANCE COMPANIES

General Provider Information

NPI Number	:	1811664246
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FIRST CHRISTIAN CHURCH OF HUNTINGTON BEACH

Provider Business Mailing Address
First Line	:	1207 MAIN ST
Second Line	:
City	:	HUNTINGTON BEACH
State	:	CA
Zip	:	92648-2720
Country	:	US
Telephone Number	:	714-536-2589
Fax Number	:

Provider Business Practice Location Address
First Line	:	1207 MAIN ST
Second Line	:
City	:	HUNTINGTON BEACH
State	:	CA
Zip	:	92648-2720
Country	:	US
Telephone Number	:	714-536-2589
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR OF FINANCE
Name	:	AMY CHITTICK
Credential	:	CPA
Telephone Number	:	714-845-5389

Provider Enumeration Date	:	08/24/2021
Last Update Date	:	08/24/2021

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