Provider Demographics
NPI:1194244772
Name:CHRISTIAN CARE CENTER OF MCKENZIE LLC
Entity type:Organization
Organization Name:CHRISTIAN CARE CENTER OF MCKENZIE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER, RISK MANAGEMENT
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:M
Authorized Official - Last Name:CAWOOD GRAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:423-557-6116
Mailing Address - Street 1:2020 NORTHPARK DR STE 2D
Mailing Address - Street 2:
Mailing Address - City:JOHNSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37604-3127
Mailing Address - Country:US
Mailing Address - Phone:423-557-6116
Mailing Address - Fax:423-975-5405
Practice Address - Street 1:150 OAK MANOR RD
Practice Address - Street 2:
Practice Address - City:MC KENZIE
Practice Address - State:TN
Practice Address - Zip Code:38201
Practice Address - Country:US
Practice Address - Phone:731-352-5317
Practice Address - Fax:731-352-5942
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-09-14
Last Update Date:2018-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
No313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility