Provider Demographics
NPI:1356335632
Name:CHRISTIAN CARE NURSING CENTER INC.
Entity type:Organization
Organization Name:CHRISTIAN CARE NURSING CENTER INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:S
Authorized Official - Last Name:NORRIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-443-5411
Mailing Address - Street 1:PO BOX 83210
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85071-3210
Mailing Address - Country:US
Mailing Address - Phone:602-861-3241
Mailing Address - Fax:602-943-6459
Practice Address - Street 1:11812 N 19TH AVE
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85029-3536
Practice Address - Country:US
Practice Address - Phone:602-861-3241
Practice Address - Fax:602-943-6459
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-01
Last Update Date:2010-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZNCIR332314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ040270Medicaid
AZ035173Medicare Oscar/Certification