Provider Demographics
NPI:1386992634
Name:CHRISTIAN NURSING
Entity type:Organization
Organization Name:CHRISTIAN NURSING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LPN
Authorized Official - Prefix:MRS
Authorized Official - First Name:COLLEEN
Authorized Official - Middle Name:
Authorized Official - Last Name:MELVILLE-TAVANTZIS
Authorized Official - Suffix:
Authorized Official - Credentials:LPN
Authorized Official - Phone:631-241-6063
Mailing Address - Street 1:25 ELAN LN
Mailing Address - Street 2:
Mailing Address - City:RONKONKOMA
Mailing Address - State:NY
Mailing Address - Zip Code:11779-1990
Mailing Address - Country:US
Mailing Address - Phone:631-696-0404
Mailing Address - Fax:
Practice Address - Street 1:25 ELAN LN
Practice Address - Street 2:
Practice Address - City:RONKONKOMA
Practice Address - State:NY
Practice Address - Zip Code:11779-1990
Practice Address - Country:US
Practice Address - Phone:631-696-0404
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-16
Last Update Date:2012-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY272421251J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care