Provider Demographics
NPI:1184615312
Name:CHRISTIAN CARE CENTERS, INC.
Entity type:Organization
Organization Name:CHRISTIAN CARE CENTERS, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:APRIL
Authorized Official - Middle Name:
Authorized Official - Last Name:MACLIN
Authorized Official - Suffix:
Authorized Official - Credentials:LNFA
Authorized Official - Phone:817-429-4198
Mailing Address - Street 1:5100 RANDOL MILL RD
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76112-1553
Mailing Address - Country:US
Mailing Address - Phone:817-429-4198
Mailing Address - Fax:866-529-7014
Practice Address - Street 1:5100 RANDOL MILL RD
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76112-1553
Practice Address - Country:US
Practice Address - Phone:817-429-4198
Practice Address - Fax:866-529-7014
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX000174314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
45-5516Medicare ID - Type Unspecified