Provider Demographics
NPI:1730126558
Name:CHRISTIAN HEALING NETWORK
Entity Type:Organization
Organization Name:CHRISTIAN HEALING NETWORK
Other - Org Name:MISSION MEDICAL CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:MARCELLA
Authorized Official - Middle Name:J
Authorized Official - Last Name:RUCH
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:719-227-0434
Mailing Address - Street 1:2125 E LA SALLE ST
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80909-2274
Mailing Address - Country:US
Mailing Address - Phone:719-219-3402
Mailing Address - Fax:719-473-3061
Practice Address - Street 1:2125 E LA SALLE ST
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80909-2274
Practice Address - Country:US
Practice Address - Phone:719-219-3402
Practice Address - Fax:719-473-3061
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0567261QC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health