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General NPI Number Information
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NPI Number | 1851306260
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Entity Type | Organization
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Legal Business Name | CHRISTIANT TABERNACLE HOME AND COMMUNITY SUPPORT SERVICE AGENCY
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Dates
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Enumeration Date | 07/31/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 4222 ROSEHILL RD SUITE 14
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City | GARLAND
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State | TX
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Zip | 75043-2503
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Country | US
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Telephone | 214-703-3292
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Fax | 214-703-3293
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Provider Business Mailing Address
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Address Line | 4222 ROSEHILL RD SUITE 14
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City | GARLAND
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State | TX
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Zip | 75043-2503
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Country | US
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Telephone | 214-703-3292
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Fax | 214-703-3293
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Authorized Official
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Title or Position | OWNER/ALT ADMINISTRATOR
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Name | MRS. JEWEL L JOHNSON
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Credential |
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Telephone | 214-703-3292
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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 |
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License Number State |
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