1699710392 NPI number — APOSTOLIC CHRISTIAN RETIREMENT HOME, INC

Table of content: (NPI 1699710392)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1699710392 NPI number — APOSTOLIC CHRISTIAN RETIREMENT HOME, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
APOSTOLIC CHRISTIAN RETIREMENT HOME, 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:
6
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:
1699710392
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
101 CONSTITUTION DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FRANCESVILLE
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
47946-8316
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
219-567-9149
Provider Business Mailing Address Fax Number:
219-567-2646

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
101 CONSTITUTION DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FRANCESVILLE
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
47946-8316
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
219-567-9149
Provider Business Practice Location Address Fax Number:
219-567-2646
Provider Enumeration Date:
06/17/2006

Additional Information

Authorized Official

Authorized Official Last Name:
STOLLER
Authorized Official First Name:
STEVE
Authorized Official Middle Name:
Authorized Official Title or Position:
ADMINASTRATOR
Authorized Official Telephone Number:
219-567-9149

Provider Taxonomy Codes

  • Taxonomy code: 310400000X , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 314000000X , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .

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

  • Identifier: 000000389220 . This is a "BLUE CROSS/BLUE SHIELD" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com