Provider Demographics
NPI:1598176976
Name:IN CHRIST FAMILY HEALTH CARE, LLC
Entity Type:Organization
Organization Name:IN CHRIST FAMILY HEALTH CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BETHANY
Authorized Official - Middle Name:CAROLEE
Authorized Official - Last Name:ROLLINS
Authorized Official - Suffix:
Authorized Official - Credentials:APRN, NP-C, FNP
Authorized Official - Phone:405-547-6222
Mailing Address - Street 1:PO BOX 1109
Mailing Address - Street 2:
Mailing Address - City:PERKINS
Mailing Address - State:OK
Mailing Address - Zip Code:74059-1109
Mailing Address - Country:US
Mailing Address - Phone:405-547-6222
Mailing Address - Fax:405-547-6223
Practice Address - Street 1:103 E WILLIAMS RD
Practice Address - Street 2:
Practice Address - City:PERKINS
Practice Address - State:OK
Practice Address - Zip Code:74059-5917
Practice Address - Country:US
Practice Address - Phone:405-547-6222
Practice Address - Fax:405-547-6223
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-19
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK71772261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200554140AMedicaid
OK361858Medicaid
OK361858Medicaid