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General NPI Number Information
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NPI Number | 1497313175
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Entity Type | Organization
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Legal Business Name | CHRISTIAN CARE CONCEPT, LLC
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Dates
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Enumeration Date | 05/29/2019
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Last Update Date | 05/29/2019
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Provider Practice Location Address
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Address Line | 575 S JEFFERSON ST
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City | DIXON
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State | CA
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Zip | 95620-3827
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Country | US
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Telephone | 707-678-1651
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Fax |
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Provider Business Mailing Address
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Address Line | 575 S JEFFERSON ST
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City | DIXON
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State | CA
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Zip | 95620-3827
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Country | US
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Telephone | 707-678-1651
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Fax |
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Authorized Official
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Title or Position | DIRECTOR, OPERATIONS
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Name | MR. PORTER MILLS
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Credential | MBA
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Telephone | 415-728-3317
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 385H00000X
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Taxonomy Name | Respite Care
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 311ZA0620X
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Taxonomy Name | Adult Care Home Facility
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License Number |
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License Number State |
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