Healthcare Provider Details

I. General information

NPI: 1669606885
Provider Name (Legal Business Name): CRISTA MINISTRIES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/04/2009
Last Update Date: 07/06/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19301 KINGS GARDEN DR N
SEATTLE WA
98133-3800
US

IV. Provider business mailing address

19303 FREMONT AVE N
SEATTLE WA
98133-3800
US

V. Phone/Fax

Practice location:
  • Phone: 206-546-7400
  • Fax: 206-546-7221
Mailing address:
  • Phone: 206-546-7400
  • Fax: 206-546-7447

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number274
License Number StateWA

VIII. Authorized Official

Name: JEFFERSON HENSON
Title or Position: EXECUTIVE DIRECTOR & ADMINISTRATOR
Credential:
Phone: 206-546-7567