Healthcare Provider Details

I. General information

NPI: 1649959891
Provider Name (Legal Business Name): CHRISTIAN PROVIDER SERVICES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/14/2023
Last Update Date: 07/14/2023
Certification Date: 07/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2415 E CAMELBACK RD STE 700
PHOENIX AZ
85016-4245
US

IV. Provider business mailing address

2415 E CAMELBACK RD STE 700
PHOENIX AZ
85016-4245
US

V. Phone/Fax

Practice location:
  • Phone: 713-261-0754
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State

VIII. Authorized Official

Name: MICHAEL OKENDU
Title or Position: OWNER
Credential:
Phone: 713-261-0754