Provider Demographics
NPI:1376935601
Name:CHRISTIAN CARE CENTERS, INC.
Entity Type:Organization
Organization Name:CHRISTIAN CARE CENTERS, INC.
Other - Org Name:CUMMINGS ASSISTED LIVING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CIO
Authorized Official - Prefix:MR
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:MARK
Authorized Official - Last Name:SPENCER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-686-2430
Mailing Address - Street 1:900 WIGGINS PKWY
Mailing Address - Street 2:
Mailing Address - City:MESQUITE
Mailing Address - State:TX
Mailing Address - Zip Code:75150-1400
Mailing Address - Country:US
Mailing Address - Phone:972-686-2430
Mailing Address - Fax:
Practice Address - Street 1:5100 RANDOL MILL RD
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76112-1553
Practice Address - Country:US
Practice Address - Phone:817-548-3200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-24
Last Update Date:2015-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX000813310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility