Provider Demographics
NPI:1699872382
Name:CRISTA MINISTRIES
Entity type:Organization
Organization Name:CRISTA MINISTRIES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT FOR SENIOR LIVING
Authorized Official - Prefix:
Authorized Official - First Name:GLEN
Authorized Official - Middle Name:
Authorized Official - Last Name:MELIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:206-289-7856
Mailing Address - Street 1:19303 FREMONT AVE N
Mailing Address - Street 2:MS#85
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98133-3800
Mailing Address - Country:US
Mailing Address - Phone:206-289-7830
Mailing Address - Fax:206-546-7447
Practice Address - Street 1:19301 KINGS GARDEN DR N
Practice Address - Street 2:
Practice Address - City:SHORELINE
Practice Address - State:WA
Practice Address - Zip Code:98133-3838
Practice Address - Country:US
Practice Address - Phone:206-546-7400
Practice Address - Fax:206-546-7221
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-17
Last Update Date:2019-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA274314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA4127403Medicaid
WA4127403Medicaid