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General NPI Number Information
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NPI Number | 1306159017
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Entity Type | Organization
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Legal Business Name | CHRISTIAN CARE NURSING CENTER INC.
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Dates
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Enumeration Date | 07/22/2010
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Last Update Date | 09/20/2010
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Provider Practice Location Address
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Address Line | 11830 N. 19TH AVE.
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City | PHOENIX
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State | AZ
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Zip | 85029
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Country | US
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Telephone | 602-443-5447
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Fax | 602-424-9447
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Provider Business Mailing Address
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Address Line | 11830 N. 19TH AVE #101
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City | PHOENIX
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State | AZ
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Zip | 85029
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Country | US
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Telephone | 602-443-5447
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Fax | 602-424-9447
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MS. KATHY LOSCHEIDER
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Credential | MBA
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Telephone | 602-443-5439
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number | HHA4807
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License Number State | AZ
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