Healthcare Provider Details

I. General information

NPI: 1871998799
Provider Name (Legal Business Name): CHRISTIAN CARE NURSING CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/04/2014
Last Update Date: 11/04/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

155 W BROWN RD
MESA AZ
85201-3427
US

IV. Provider business mailing address

PO BOX 83210
PHOENIX AZ
85071-3210
US

V. Phone/Fax

Practice location:
  • Phone: 480-290-7952
  • Fax: 480-398-2727
Mailing address:
  • Phone: 602-443-5439
  • Fax: 602-443-5499

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License NumberOTC5456
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code261QR0400X
TaxonomyRehabilitation Clinic/Center
License NumberOTC5456
License Number StateAZ

VIII. Authorized Official

Name: MS. KATHY LOSCHEIDER
Title or Position: EXECUTIVE DIRECTOR
Credential: MBA
Phone: 602-443-5439