Provider Demographics
NPI:1255478210
Name:CHRISTIAN CARE COMMUNITIES, INC.
Entity Type:Organization
Organization Name:CHRISTIAN CARE COMMUNITIES, INC.
Other - Org Name:CHRISTIAN HEALTH CENTER CORBIN
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:DADDS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:502-254-4208
Mailing Address - Street 1:12710 TOWNEPARK WAY
Mailing Address - Street 2:SUITE 1000
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40243-1596
Mailing Address - Country:US
Mailing Address - Phone:502-254-4200
Mailing Address - Fax:
Practice Address - Street 1:116 S COMMONWEALTH AVE
Practice Address - Street 2:
Practice Address - City:CORBIN
Practice Address - State:KY
Practice Address - Zip Code:40701-6408
Practice Address - Country:US
Practice Address - Phone:606-258-2500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-31
Last Update Date:2014-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY100540314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000054502OtherANTHEM BLUE CROSS
KY12504510Medicaid
KY000000054502OtherANTHEM BLUE CROSS