Provider Demographics
NPI:1609321660
Name:EVANSVILLE CHRISTIAN LIFE CENTER INC
Entity type:Organization
Organization Name:EVANSVILLE CHRISTIAN LIFE CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF ADMINISTRATION
Authorized Official - Prefix:
Authorized Official - First Name:SUSIE
Authorized Official - Middle Name:K
Authorized Official - Last Name:ATHERTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:812-423-9222
Mailing Address - Street 1:509 S KENTUCKY AVE
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47714-1091
Mailing Address - Country:US
Mailing Address - Phone:812-423-9222
Mailing Address - Fax:812-428-8441
Practice Address - Street 1:265 BELLEMEADE AVE
Practice Address - Street 2:
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47713-1775
Practice Address - Country:US
Practice Address - Phone:812-426-6152
Practice Address - Fax:812-426-6160
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-19
Last Update Date:2016-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center