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General NPI Number Information
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NPI Number | 1396993036
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Entity Type | Organization
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Legal Business Name | CHRISTINE PROFESSIONAL HEALTH CARE INC
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Dates
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Enumeration Date | 09/07/2008
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Last Update Date | 09/07/2008
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Provider Practice Location Address
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Address Line | 9970 MADISON ST NE
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City | BLAINE
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State | MN
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Zip | 55434-4207
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Country | US
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Telephone | 763-464-4072
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Fax | 763-784-9322
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Provider Business Mailing Address
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Address Line | 9970 MADISON ST NE
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City | BLAINE
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State | MN
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Zip | 55434-4207
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Country | US
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Telephone | 763-464-4072
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Fax | 763-784-9322
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Authorized Official
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Title or Position | DIRECTOR
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Name | MIKE OSARO OHENZUWA
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Credential | M.A.
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Telephone | 763-464-4072
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number | HE0108404
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License Number State | MN
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