Provider Demographics
NPI:1548203011
Name:CHRISTIAN CARE CENTERS, INC.
Entity type:Organization
Organization Name:CHRISTIAN CARE CENTERS, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SENIOR VICE PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARY
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:CHENNAULT
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:972-686-3755
Mailing Address - Street 1:1000 WIGGINS PKWY
Mailing Address - Street 2:
Mailing Address - City:MESQUITE
Mailing Address - State:TX
Mailing Address - Zip Code:75150-7465
Mailing Address - Country:US
Mailing Address - Phone:972-613-7945
Mailing Address - Fax:972-682-7947
Practice Address - Street 1:1000 WIGGINS PKWY
Practice Address - Street 2:
Practice Address - City:MESQUITE
Practice Address - State:TX
Practice Address - Zip Code:75150-7465
Practice Address - Country:US
Practice Address - Phone:972-613-7945
Practice Address - Fax:972-682-7947
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-13
Last Update Date:2008-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX0010470251G00000X
TX001565251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
671548Medicare Oscar/Certification
678148Medicare Oscar/Certification