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General NPI Number Information
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NPI Number | 1962847079
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Entity Type | Organization
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Legal Business Name | CHRISTIAN HOME CARE SERVICES
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Dates
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Enumeration Date | 05/02/2013
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Last Update Date | 05/02/2013
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Provider Practice Location Address
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Address Line | 209 E CHIPPEWA ST
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City | MT PLEASANT
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State | MI
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Zip | 48858-1609
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Country | US
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Telephone | 989-772-1261
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Fax |
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Provider Business Mailing Address
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Address Line | 1132 CHEESMAN
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City | SAINT LOUIS
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State | MI
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Zip | 48880-9402
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Country | US
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Telephone | 989-763-1016
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MR. KENT VANDERLOON
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Credential |
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Telephone | 989-772-1261
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 302R00000X
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Taxonomy Name | Health Maintenance Organization
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License Number | 4703085412
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License Number State | MI
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