Healthcare Provider Details

I. General information

NPI: 1801989801
Provider Name (Legal Business Name): CHRISTIAN HEALTH CARE OF NIXA, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/02/2006
Last Update Date: 12/20/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1104 N MAIN ST
NIXA MO
65714-9316
US

IV. Provider business mailing address

222 S 1ST ST
ROGERS AR
72756-4504
US

V. Phone/Fax

Practice location:
  • Phone: 417-725-1777
  • Fax: 417-725-4975
Mailing address:
  • Phone: 479-464-0200
  • Fax: 479-464-8098

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number032176
License Number StateMO

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier102465002
Identifier TypeMEDICAID
Identifier StateMO
Identifier Issuer

VIII. Authorized Official

Name: THOMAS STAYTON
Title or Position: PRESIDENT
Credential:
Phone: 417-891-9939