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General NPI Number Information
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NPI Number | 1245955913
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Entity Type | Organization
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Legal Business Name | CHRISTIAN CARE SURPRISE, INC.
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Dates
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Enumeration Date | 10/05/2022
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Last Update Date | 10/05/2022
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Provider Practice Location Address
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Address Line | 16640 N SARIVAL RD
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City | SURPRISE
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State | AZ
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Zip | 85388-2202
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Country | US
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Telephone | 623-300-9401
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Fax | 623-432-0276
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Provider Business Mailing Address
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Address Line | 16477 W BELL RD
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City | SURPRISE
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State | AZ
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Zip | 85374-6603
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Country | US
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Telephone | 623-300-9401
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | JAMI F GROSS
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Credential |
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Telephone | 623-300-9401
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0400X
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Taxonomy Name | Rehabilitation Clinic/Center
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License Number |
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License Number State |
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