Provider Demographics
NPI:1295920890
Name:CHRISTIAN CARE CENTER OF JOHNSON CITY, INC.
Entity type:Organization
Organization Name:CHRISTIAN CARE CENTER OF JOHNSON CITY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RISK MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:LISA
Authorized Official - Middle Name:M
Authorized Official - Last Name:CAWOOD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:423-773-4485
Mailing Address - Street 1:140 TECHNOLOGY LANE
Mailing Address - Street 2:
Mailing Address - City:JOHNSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37604
Mailing Address - Country:US
Mailing Address - Phone:423-434-2016
Mailing Address - Fax:423-926-0812
Practice Address - Street 1:140 TECHNOLOGY LANE
Practice Address - Street 2:
Practice Address - City:JOHNSON CITY
Practice Address - State:TN
Practice Address - Zip Code:37604
Practice Address - Country:US
Practice Address - Phone:423-434-2016
Practice Address - Fax:423-926-0812
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-07
Last Update Date:2008-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000000388313M00000X, 314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
No313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN7440605Medicaid
TN7440605Medicaid
445487Medicare Oscar/Certification