Provider Demographics
NPI:1215131990
Name:CHRISTIAN CARE ASSISTED LIVING (PHOENIX), INC.
Entity type:Organization
Organization Name:CHRISTIAN CARE ASSISTED LIVING (PHOENIX), INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:KATHRYN
Authorized Official - Middle Name:
Authorized Official - Last Name:LOSCHEIDER
Authorized Official - Suffix:
Authorized Official - Credentials:MBA, NHA
Authorized Official - Phone:602-443-5439
Mailing Address - Street 1:11818 N 19TH AVE
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85029-3577
Mailing Address - Country:US
Mailing Address - Phone:602-443-5439
Mailing Address - Fax:602-443-5499
Practice Address - Street 1:11818 N 19TH AVE
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85029-3577
Practice Address - Country:US
Practice Address - Phone:602-443-5439
Practice Address - Fax:602-443-5499
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZALC-4652310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility