Provider Demographics
NPI:1124383138
Name:CHRISTIAN COMPANION SENIOR CARE
Entity Type:Organization
Organization Name:CHRISTIAN COMPANION SENIOR CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:KERRY
Authorized Official - Middle Name:
Authorized Official - Last Name:SIDES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:308-530-6027
Mailing Address - Street 1:521 S BRYAN AVE
Mailing Address - Street 2:
Mailing Address - City:NORTH PLATTE
Mailing Address - State:NE
Mailing Address - Zip Code:69101-5604
Mailing Address - Country:US
Mailing Address - Phone:308-530-6027
Mailing Address - Fax:877-455-6041
Practice Address - Street 1:521 S BRYAN AVE
Practice Address - Street 2:
Practice Address - City:NORTH PLATTE
Practice Address - State:NE
Practice Address - Zip Code:69101-5604
Practice Address - Country:US
Practice Address - Phone:308-530-6027
Practice Address - Fax:877-455-6041
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-06
Last Update Date:2012-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR11128251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health