Provider Demographics
NPI:1316935422
Name:CHRIST'S SANCTIFIED HOLY CHURCH, INC.
Entity type:Organization
Organization Name:CHRIST'S SANCTIFIED HOLY CHURCH, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:KATHY
Authorized Official - Middle Name:
Authorized Official - Last Name:GIBBS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:478-987-1239
Mailing Address - Street 1:PO BOX 1376
Mailing Address - Street 2:
Mailing Address - City:PERRY
Mailing Address - State:GA
Mailing Address - Zip Code:31069-1376
Mailing Address - Country:US
Mailing Address - Phone:478-987-1239
Mailing Address - Fax:478-988-8273
Practice Address - Street 1:2470 US HIGHWAY 41
Practice Address - Street 2:
Practice Address - City:FORT VALLEY
Practice Address - State:GA
Practice Address - Zip Code:31030-8716
Practice Address - Country:US
Practice Address - Phone:478-987-1239
Practice Address - Fax:478-988-8273
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CHRIST'S SANCTIIFIED HOLY CHURCH, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-10-12
Last Update Date:2011-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA20635S314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA004140467AMedicaid
GA004140467AMedicaid