Provider Demographics
NPI:1851306260
Name:CHRISTIANT TABERNACLE HOME AND COMMUNITY SUPPORT SERVICE AGENCY
Entity Type:Organization
Organization Name:CHRISTIANT TABERNACLE HOME AND COMMUNITY SUPPORT SERVICE AGENCY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ALT ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:JEWEL
Authorized Official - Middle Name:L
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-703-3292
Mailing Address - Street 1:4222 ROSEHILL RD
Mailing Address - Street 2:SUITE 14
Mailing Address - City:GARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:75043-2503
Mailing Address - Country:US
Mailing Address - Phone:214-703-3292
Mailing Address - Fax:214-703-3293
Practice Address - Street 1:4222 ROSEHILL RD
Practice Address - Street 2:SUITE 14
Practice Address - City:GARLAND
Practice Address - State:TX
Practice Address - Zip Code:75043-2503
Practice Address - Country:US
Practice Address - Phone:214-703-3292
Practice Address - Fax:214-703-3293
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-31
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health