Provider Demographics
NPI:1689425159
Name:CHRISTIAN LOVE PHC, LLC
Entity Type:Organization
Organization Name:CHRISTIAN LOVE PHC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CONITINA
Authorized Official - Middle Name:KAY
Authorized Official - Last Name:HUTTO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:936-332-6509
Mailing Address - Street 1:908 US HIGHWAY 84 E
Mailing Address - Street 2:
Mailing Address - City:TENAHA
Mailing Address - State:TX
Mailing Address - Zip Code:75974-4547
Mailing Address - Country:US
Mailing Address - Phone:936-332-6509
Mailing Address - Fax:
Practice Address - Street 1:908 US HIGHWAY 84 E
Practice Address - Street 2:
Practice Address - City:TENAHA
Practice Address - State:TX
Practice Address - Zip Code:75974-4547
Practice Address - Country:US
Practice Address - Phone:936-332-6509
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-01
Last Update Date:2024-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health