MEDICARE: CHRISTOPHER'S PLACE RETIREMENT HOME

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	310400000X	Assisted Living Facility

General Provider Information

NPI Number	:	1831522705
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHRISTOPHER'S PLACE RETIREMENT HOME

Provider Business Mailing Address
First Line	:	3586 53RD AVE N
Second Line	:
City	:	ST PETERSBURG
State	:	FL
Zip	:	33714-2412
Country	:	US
Telephone Number	:	727-688-1918
Fax Number	:	727-824-6364

Provider Business Practice Location Address
First Line	:	3586 53RD AVE N
Second Line	:
City	:	ST PETERSBURG
State	:	FL
Zip	:	33714-2412
Country	:	US
Telephone Number	:	727-688-1918
Fax Number	:	727-824-6364

Authorized Official
Title or Position	:	OWNER
Name	:	MS. VALDENE FORDE
Credential	:
Telephone Number	:	727-688-1918

Provider Enumeration Date	:	08/15/2013
Last Update Date	:	08/15/2013

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