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General NPI Number Information
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NPI Number | 1205973500
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Entity Type | Organization
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Legal Business Name | CHRISTIAN CARE COMMUNITIES, INC.
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Dates
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Enumeration Date | 01/30/2007
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Last Update Date | 05/13/2014
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Provider Practice Location Address
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Address Line | 1800 WESTEN ST
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City | BOWLING GREEN
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State | KY
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Zip | 42104-5843
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Country | US
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Telephone | 502-254-4200
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Fax |
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Provider Business Mailing Address
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Address Line | 12710 TOWNEPARK WAY SUITE 1000
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City | LOUISVILLE
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State | KY
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Zip | 40243-1596
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Country | US
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Telephone | 502-254-4200
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Fax |
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Authorized Official
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Title or Position | VICE PRESIDENT CFO
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Name | MR. JOHN DADDS
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Credential |
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Telephone | 502-254-4208
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number | 100691
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License Number State | KY
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