Provider Demographics
NPI:1689740375
Name:EVANSVILLE CHRISTIAN LIFE CENTER INC
Entity Type:Organization
Organization Name:EVANSVILLE CHRISTIAN LIFE CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL CARE SERVICES MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LOIS
Authorized Official - Middle Name:
Authorized Official - Last Name:ARMITAGE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:812-426-6152
Mailing Address - Street 1:509 S KENTUCKY AVE
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47714-1091
Mailing Address - Country:US
Mailing Address - Phone:812-423-9222
Mailing Address - Fax:812-428-8441
Practice Address - Street 1:265 BELLEMEADE AVE
Practice Address - Street 2:
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47713-1775
Practice Address - Country:US
Practice Address - Phone:812-426-6152
Practice Address - Fax:812-426-6160
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-27
Last Update Date:2016-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN0005058783261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100180700AMedicaid
IN100180700AMedicaid