Provider Demographics
NPI:1679024772
Name:CHRISTIAN HEALTHCARE OF MD LLC
Entity Type:Organization
Organization Name:CHRISTIAN HEALTHCARE OF MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JANINE
Authorized Official - Middle Name:
Authorized Official - Last Name:WISSINGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:443-804-3408
Mailing Address - Street 1:12947 HARFORD RD
Mailing Address - Street 2:
Mailing Address - City:HYDES
Mailing Address - State:MD
Mailing Address - Zip Code:21082-9503
Mailing Address - Country:US
Mailing Address - Phone:410-592-7270
Mailing Address - Fax:
Practice Address - Street 1:12947 HARFORD RD
Practice Address - Street 2:
Practice Address - City:HYDES
Practice Address - State:MD
Practice Address - Zip Code:21082-9503
Practice Address - Country:US
Practice Address - Phone:410-592-7270
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-24
Last Update Date:2016-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR2960251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD2996031-00Medicaid