Healthcare Provider Details

I. General information

NPI: 1497313175
Provider Name (Legal Business Name): CHRISTIAN CARE CONCEPT, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/29/2019
Last Update Date: 05/29/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

575 S JEFFERSON ST
DIXON CA
95620-3827
US

IV. Provider business mailing address

575 S JEFFERSON ST
DIXON CA
95620-3827
US

V. Phone/Fax

Practice location:
  • Phone: 707-678-1651
  • Fax:
Mailing address:
  • Phone: 707-678-1651
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code311ZA0620X
TaxonomyAdult Care Home Facility
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State

VIII. Authorized Official

Name: MR. PORTER MILLS
Title or Position: DIRECTOR, OPERATIONS
Credential: MBA
Phone: 415-728-3317