Provider Demographics
NPI:1245955913
Name:CHRISTIAN CARE SURPRISE, INC.
Entity type:Organization
Organization Name:CHRISTIAN CARE SURPRISE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JAMI
Authorized Official - Middle Name:F
Authorized Official - Last Name:GROSS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:623-300-9401
Mailing Address - Street 1:16477 W BELL RD
Mailing Address - Street 2:
Mailing Address - City:SURPRISE
Mailing Address - State:AZ
Mailing Address - Zip Code:85374-6603
Mailing Address - Country:US
Mailing Address - Phone:623-300-9401
Mailing Address - Fax:
Practice Address - Street 1:16640 N SARIVAL RD
Practice Address - Street 2:
Practice Address - City:SURPRISE
Practice Address - State:AZ
Practice Address - Zip Code:85388-2202
Practice Address - Country:US
Practice Address - Phone:623-300-9401
Practice Address - Fax:623-432-0276
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CHRISTIAN CARE SURPRISE, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-10-05
Last Update Date:2022-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation