Provider Demographics
NPI:1760830749
Name:CHRISTIAN NURSING REGISTRY
Entity type:Organization
Organization Name:CHRISTIAN NURSING REGISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JOANE
Authorized Official - Middle Name:
Authorized Official - Last Name:PHANORD
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:631-388-4269
Mailing Address - Street 1:11 FAULKNER AVE
Mailing Address - Street 2:
Mailing Address - City:NORTH BABYLON
Mailing Address - State:NY
Mailing Address - Zip Code:11703-2604
Mailing Address - Country:US
Mailing Address - Phone:631-388-4269
Mailing Address - Fax:
Practice Address - Street 1:11 FAULKNER AVE
Practice Address - Street 2:
Practice Address - City:NORTH BABYLON
Practice Address - State:NY
Practice Address - Zip Code:11703
Practice Address - Country:US
Practice Address - Phone:631-388-4269
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HOME CARE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-05-31
Last Update Date:2016-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY64723-1251J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care