Provider Demographics
NPI:1063804995
Name:CHRISTIAN GLOBAL MEDICAL HEALTHCARE INCORPORATED
Entity type:Organization
Organization Name:CHRISTIAN GLOBAL MEDICAL HEALTHCARE INCORPORATED
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:MANJERNGIE
Authorized Official - Middle Name:CECELIA
Authorized Official - Last Name:NDEBE
Authorized Official - Suffix:
Authorized Official - Credentials:FNP-C, PHD
Authorized Official - Phone:269-352-0655
Mailing Address - Street 1:451 W MILHAM AVE
Mailing Address - Street 2:
Mailing Address - City:PORTAGE
Mailing Address - State:MI
Mailing Address - Zip Code:49024-2721
Mailing Address - Country:US
Mailing Address - Phone:269-488-9007
Mailing Address - Fax:269-488-9001
Practice Address - Street 1:451 W MILHAM AVE
Practice Address - Street 2:
Practice Address - City:PORTAGE
Practice Address - State:MI
Practice Address - Zip Code:49024-2721
Practice Address - Country:US
Practice Address - Phone:269-488-9007
Practice Address - Fax:269-488-9001
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CHRISTIAN GLOBAL MEDICAL HEALTHCARE INCORPORATED
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-03-02
Last Update Date:2015-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIMI8282001OtherMEDICARE PTAN