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General NPI Number Information
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NPI Number | 1386992634
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Entity Type | Organization
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Legal Business Name | CHRISTIAN NURSING
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Dates
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Enumeration Date | 08/16/2012
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Last Update Date | 08/16/2012
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Provider Practice Location Address
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Address Line | 25 ELAN LN
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City | RONKONKOMA
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State | NY
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Zip | 11779-1990
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Country | US
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Telephone | 631-696-0404
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Fax |
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Provider Business Mailing Address
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Address Line | 25 ELAN LN
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City | RONKONKOMA
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State | NY
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Zip | 11779-1990
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Country | US
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Telephone | 631-696-0404
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Fax |
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Authorized Official
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Title or Position | LPN
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Name | MRS. COLLEEN MELVILLE-TAVANTZIS
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Credential | LPN
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Telephone | 631-241-6063
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251J00000X
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Taxonomy Name | Nursing Care Agency
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License Number | 272421
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License Number State | NY
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