Provider Demographics
NPI:1174928618
Name:CHRISTIAN CARE NURSING CENTER, INC.
Entity type:Organization
Organization Name:CHRISTIAN CARE NURSING CENTER, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:KATHY
Authorized Official - Middle Name:
Authorized Official - Last Name:LOSCHEIDER
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:602-443-5439
Mailing Address - Street 1:11812 N 19TH AVE
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85029-3536
Mailing Address - Country:US
Mailing Address - Phone:602-443-5400
Mailing Address - Fax:602-443-5449
Practice Address - Street 1:11830 N 19TH AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85029-3519
Practice Address - Country:US
Practice Address - Phone:602-443-5447
Practice Address - Fax:602-443-5449
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CHRISTIAN CARE NURSING CENTER, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-10-27
Last Update Date:2014-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZOTC4861261QP2000X, 261QR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation
No261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZOTC4861OtherADHS