Provider Demographics
NPI:1598020703
Name:CHRISTOPHER'S PERSONAL CARE HOME, LLC
Entity Type:Organization
Organization Name:CHRISTOPHER'S PERSONAL CARE HOME, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:GAIL
Authorized Official - Middle Name:M
Authorized Official - Last Name:HOUCK
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:662-551-1122
Mailing Address - Street 1:885 HIGHWAY 178 E
Mailing Address - Street 2:
Mailing Address - City:HOLLY SPRINGS
Mailing Address - State:MS
Mailing Address - Zip Code:38635-2641
Mailing Address - Country:US
Mailing Address - Phone:662-551-1122
Mailing Address - Fax:662-551-1635
Practice Address - Street 1:885 HIGHWAY 178 E
Practice Address - Street 2:
Practice Address - City:HOLLY SPRINGS
Practice Address - State:MS
Practice Address - Zip Code:38635-2641
Practice Address - Country:US
Practice Address - Phone:662-551-1122
Practice Address - Fax:662-551-1635
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-13
Last Update Date:2012-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS871310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility