1750742995 NPI number — C3 CHRISTIAN ACADEMY, INC.

Table of content: (NPI 1750742995)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1750742995 NPI number — C3 CHRISTIAN ACADEMY, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
C3 CHRISTIAN ACADEMY, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1750742995
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/16/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2001 108TH ST
Provider Second Line Business Mailing Address:
STE. 102
Provider Business Mailing Address City Name:
GRAND PRAIRIE
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75050-1437
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
972-623-2322
Provider Business Mailing Address Fax Number:
972-623-2322

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2001 108TH ST
Provider Second Line Business Practice Location Address:
STE. 102
Provider Business Practice Location Address City Name:
GRAND PRAIRIE
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75050-1437
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
972-623-2322
Provider Business Practice Location Address Fax Number:
972-623-2322
Provider Enumeration Date:
03/16/2016

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
EVANS-DAVIS
Authorized Official First Name:
TRISHA
Authorized Official Middle Name:
ANN
Authorized Official Title or Position:
PROGRAM ADMINISTRATOR
Authorized Official Telephone Number:
817-875-2535

Provider Taxonomy Codes

  • Taxonomy code: 261QA0600X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)