Provider Demographics
NPI:1437891678
Name:CHRISTIAN CARE MANAGEMENT II, INC.
Entity Type:Organization
Organization Name:CHRISTIAN CARE MANAGEMENT II, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ASSISTED LIVING DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:TAWNYA
Authorized Official - Middle Name:
Authorized Official - Last Name:CHRISTENSEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-654-1800
Mailing Address - Street 1:6945 E MAIN ST BLDG 5
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85207-8206
Mailing Address - Country:US
Mailing Address - Phone:480-654-1800
Mailing Address - Fax:
Practice Address - Street 1:159 S. POWER ROAD
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85206
Practice Address - Country:US
Practice Address - Phone:480-654-1800
Practice Address - Fax:480-218-2617
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-08
Last Update Date:2022-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3104A0625XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Mental Illness
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ078539Medicaid