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General NPI Number Information
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NPI Number | 1922125319
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Entity Type | Organization
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Legal Business Name | CHRISTIAN CARE COMMUNITIES, INC.
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Dates
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Enumeration Date | 03/23/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 116 COMMONWEALTH AVE
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City | CORBIN
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State | KY
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Zip | 40701
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Country | US
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Telephone | 606-258-2500
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Fax |
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Provider Business Mailing Address
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Address Line | 12700 SHELBYVILLE RD
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City | LOUISVILLE
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State | KY
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Zip | 40243-1576
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | VICE PRESIDENT CFO
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Name | MR. W RICHARD MARSHALL
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Credential |
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Telephone | 502-254-4200
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336L0003X
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Taxonomy Name | Long Term Care Pharmacy
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License Number | 54022520
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License Number State | KY
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