Provider Demographics
NPI:1720348626
Name:CHRISTIAN SENIOR CARE OF ARIZONA LLC
Entity Type:Organization
Organization Name:CHRISTIAN SENIOR CARE OF ARIZONA LLC
Other - Org Name:CHRISTIAN COMPANION SENIOR CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:GENERAL MANGER
Authorized Official - Prefix:MR
Authorized Official - First Name:GREGG
Authorized Official - Middle Name:
Authorized Official - Last Name:POWELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-285-1774
Mailing Address - Street 1:4809 E THISTLE LANDING DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85044-6498
Mailing Address - Country:US
Mailing Address - Phone:480-285-1774
Mailing Address - Fax:
Practice Address - Street 1:4809 E THISTLE LANDING DR
Practice Address - Street 2:SUITE 100
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85044-6498
Practice Address - Country:US
Practice Address - Phone:480-285-1774
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-24
Last Update Date:2012-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health