Provider Demographics
NPI:1558797613
Name:CHRIST COMMUNITY HEALTH SERVICES INC
Entity Type:Organization
Organization Name:CHRIST COMMUNITY HEALTH SERVICES INC
Other - Org Name:CHRIST COMMUNITY HEALTH SERVICES, INC.-ORANGE MOUND PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:SHANTELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:LEATHERWOOD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:901-842-3160
Mailing Address - Street 1:2595 CENTRAL AVE
Mailing Address - Street 2:ATTENTION: PHARMACY DIRECTOR
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38104-5905
Mailing Address - Country:US
Mailing Address - Phone:901-260-8550
Mailing Address - Fax:901-260-8598
Practice Address - Street 1:2569 DOUGLASS AVE
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38114-2532
Practice Address - Country:US
Practice Address - Phone:901-271-6275
Practice Address - Fax:901-271-6276
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-20
Last Update Date:2023-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
TN00000052323336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3707256Medicaid
2142134OtherPK