Provider Demographics
NPI:1306159017
Name:CHRISTIAN CARE NURSING CENTER INC.
Entity type:Organization
Organization Name:CHRISTIAN CARE NURSING CENTER INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:KATHY
Authorized Official - Middle Name:
Authorized Official - Last Name:LOSCHEIDER
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:602-443-5439
Mailing Address - Street 1:11830 N. 19TH AVE
Mailing Address - Street 2:#101
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85029
Mailing Address - Country:US
Mailing Address - Phone:602-443-5447
Mailing Address - Fax:602-424-9447
Practice Address - Street 1:11830 N. 19TH AVE.
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85029
Practice Address - Country:US
Practice Address - Phone:602-443-5447
Practice Address - Fax:602-424-9447
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-22
Last Update Date:2010-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZHHA4807251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZHHA4807OtherAZ DEPT HEALTH SERVICES