Provider Demographics
NPI:1164703955
Name:CHRISTIAN HEALTH CENTER - WEST, INC.
Entity Type:Organization
Organization Name:CHRISTIAN HEALTH CENTER - WEST, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:KEITH
Authorized Official - Middle Name:R
Authorized Official - Last Name:KNAPP
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:502-254-4200
Mailing Address - Street 1:1015 MAGAZINE ST
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40203-2017
Mailing Address - Country:US
Mailing Address - Phone:502-254-4201
Mailing Address - Fax:502-254-4209
Practice Address - Street 1:1015 MAGAZINE ST
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40203-2017
Practice Address - Country:US
Practice Address - Phone:502-254-4201
Practice Address - Fax:502-254-4209
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CHRISTIAN CARE COMMUNITIES, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-09-07
Last Update Date:2014-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY100536314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100197160Medicaid
185468OtherMEDICARE