Provider Demographics
NPI:1497313175
Name:CHRISTIAN CARE CONCEPT, LLC
Entity Type:Organization
Organization Name:CHRISTIAN CARE CONCEPT, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR, OPERATIONS
Authorized Official - Prefix:MR
Authorized Official - First Name:PORTER
Authorized Official - Middle Name:
Authorized Official - Last Name:MILLS
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:415-728-3317
Mailing Address - Street 1:575 S JEFFERSON ST
Mailing Address - Street 2:
Mailing Address - City:DIXON
Mailing Address - State:CA
Mailing Address - Zip Code:95620-3827
Mailing Address - Country:US
Mailing Address - Phone:707-678-1651
Mailing Address - Fax:
Practice Address - Street 1:575 S JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:DIXON
Practice Address - State:CA
Practice Address - Zip Code:95620-3827
Practice Address - Country:US
Practice Address - Phone:707-678-1651
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-29
Last Update Date:2019-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home
No385H00000XRespite Care FacilityRespite Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA486801928OtherCOMMUNITY CARE LICENSING