MEDICARE: CHRISTIAN COMMUNITY DELIVERANCE CHURCH

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
1	251E00000X	Home Health Agency	4315	MN

General Provider Information

NPI Number	:	1518405083
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHRISTIAN COMMUNITY DELIVERANCE CHURCH

Provider Business Mailing Address
First Line	:	13421 CEDAR AVE
Second Line	:
City	:	APPLE VALLEY
State	:	MN
Zip	:	55124-8530
Country	:	US
Telephone Number	:	612-275-5132
Fax Number	:

Provider Business Practice Location Address
First Line	:	13421 CEDAR AVE
Second Line	:
City	:	APPLE VALLEY
State	:	MN
Zip	:	55124-8530
Country	:	US
Telephone Number	:	612-275-5132
Fax Number	:

Authorized Official
Title or Position	:	PRSIDENT
Name	:	MILLICENT SAWYERR
Credential	:
Telephone Number	:	612-275-5132

Provider Enumeration Date	:	02/05/2017
Last Update Date	:	02/05/2017

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