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NPI Code Detail

MEDICARE: CHRISTIAN CARE CENTERS, INC.

MEDICARE: CHRISTIAN CARE CENTERS, INC.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1310400000XAssisted Living Facility000813TX

General Provider Information

NPI Number : 1376935601
Entity Type Code : Organization
Provider Name (Legal Business Name) : CHRISTIAN CARE CENTERS, INC.
Provider Business Mailing Address
First Line : 900 WIGGINS PKWY
Second Line :
City : MESQUITE
State : TX
Zip : 75150-1400
Country : US
Telephone Number : 972-686-2430
Fax Number :
Provider Business Practice Location Address
First Line : 5100 RANDOL MILL RD
Second Line :
City : FORT WORTH
State : TX
Zip : 76112-1553
Country : US
Telephone Number : 817-548-3200
Fax Number :
Authorized Official
Title or Position : CIO
Name : MR. JONATHAN MARK SPENCER
Credential :
Telephone Number : 972-686-2430
Provider Enumeration Date : 02/24/2015
Last Update Date : 02/24/2015

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Directions to “CHRISTIAN CARE CENTERS, INC. ” Practice Location

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