Provider Demographics
NPI:1912901505
Name:CHRISTIAN HOMES, INC.
Entity Type:Organization
Organization Name:CHRISTIAN HOMES, INC.
Other - Org Name:CHRISTIAN HOMES HEALTH CARE, CHRISOMA WEST
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:W
Authorized Official - Last Name:BAKKE
Authorized Official - Suffix:
Authorized Official - Credentials:NURSING HOME ADMIN
Authorized Official - Phone:308-995-4493
Mailing Address - Street 1:1923 W 4TH AVE
Mailing Address - Street 2:
Mailing Address - City:HOLDREGE
Mailing Address - State:NE
Mailing Address - Zip Code:68949-3113
Mailing Address - Country:US
Mailing Address - Phone:308-995-4493
Mailing Address - Fax:308-995-8702
Practice Address - Street 1:1923 WEST 4TH AVENUE
Practice Address - Street 2:
Practice Address - City:HOLDREGE
Practice Address - State:NE
Practice Address - Zip Code:68949-3113
Practice Address - Country:US
Practice Address - Phone:308-995-4493
Practice Address - Fax:308-995-8702
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MIDWEST DISTRICT OF THE EVANGELICAL FREE CHURCH OF AMERICA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-06-10
Last Update Date:2013-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NEALF030310400000X
NE614002314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
No310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE28D0652676OtherCLIA NUMBER
NE614002OtherNEBRASKA SKILLED LICENSE
NEALF030OtherNE ASSISTED LIV. LICENSE
NEALF030OtherNE ASSISTED LIV. LICENSE
NE614002OtherNEBRASKA SKILLED LICENSE
NE28D0652676OtherCLIA NUMBER
NE0304130001Medicare NSC