Provider Demographics
NPI:1831522705
Name:CHRISTOPHER'S PLACE RETIREMENT HOME
Entity type:Organization
Organization Name:CHRISTOPHER'S PLACE RETIREMENT HOME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:VALDENE
Authorized Official - Middle Name:
Authorized Official - Last Name:FORDE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:727-688-1918
Mailing Address - Street 1:3586 53RD AVE N
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33714-2412
Mailing Address - Country:US
Mailing Address - Phone:727-688-1918
Mailing Address - Fax:727-824-6364
Practice Address - Street 1:3586 53RD AVE N
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33714-2412
Practice Address - Country:US
Practice Address - Phone:727-688-1918
Practice Address - Fax:727-824-6364
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-15
Last Update Date:2013-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility