Provider Demographics
NPI:1710095641
Name:CHRISTIAN CARE
Entity Type:Organization
Organization Name:CHRISTIAN CARE
Other - Org Name:CHRISTIAN CARE NURSING CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF FINANCE
Authorized Official - Prefix:MS
Authorized Official - First Name:LISA
Authorized Official - Middle Name:
Authorized Official - Last Name:KROESING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:231-722-7165
Mailing Address - Street 1:2053 S SHERIDAN
Mailing Address - Street 2:
Mailing Address - City:MUSKEGON
Mailing Address - State:MI
Mailing Address - Zip Code:49442
Mailing Address - Country:US
Mailing Address - Phone:231-722-7165
Mailing Address - Fax:231-722-7603
Practice Address - Street 1:2053 S SHERIDAN DR
Practice Address - Street 2:
Practice Address - City:MUSKEGON
Practice Address - State:MI
Practice Address - Zip Code:49442-6254
Practice Address - Country:US
Practice Address - Phone:231-722-7165
Practice Address - Fax:231-722-7603
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-29
Last Update Date:2022-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI614010311500000X, 313M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
No311500000XNursing & Custodial Care FacilitiesAlzheimer Center (Dementia Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2151292Medicaid