Provider Demographics
NPI:1750742995
Name:C3 CHRISTIAN ACADEMY, INC.
Entity type:Organization
Organization Name:C3 CHRISTIAN ACADEMY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:TRISHA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:EVANS-DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:817-875-2535
Mailing Address - Street 1:2001 108TH ST
Mailing Address - Street 2:STE. 102
Mailing Address - City:GRAND PRAIRIE
Mailing Address - State:TX
Mailing Address - Zip Code:75050-1437
Mailing Address - Country:US
Mailing Address - Phone:972-623-2322
Mailing Address - Fax:972-623-2322
Practice Address - Street 1:2001 108TH ST
Practice Address - Street 2:STE. 102
Practice Address - City:GRAND PRAIRIE
Practice Address - State:TX
Practice Address - Zip Code:75050-1437
Practice Address - Country:US
Practice Address - Phone:972-623-2322
Practice Address - Fax:972-623-2322
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-16
Last Update Date:2016-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care