# CHRISTIAN CARE CENTER OF JOHNSON CITY, INC.

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1295920890
- **Authorized official:** MS. LISA M CAWOOD (RISK MANAGER)
- **Authorized official phone:** (423) 773-4485

## Contact information

- **Practice address:** 140 TECHNOLOGY LANE, JOHNSON CITY, TN 37604
- **Practice address phone:** (423) 434-2016
- **Practice address fax:** (423) 926-0812
- **Mailing address:** 140 TECHNOLOGY LANE, JOHNSON CITY, TN 37604
- **Mailing address phone:** (423) 434-2016
- **Mailing address fax:** (423) 926-0812

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 313M00000X | Nursing Facility/Intermediate Care Facility | 0000000388 | TN | — |
| 314000000X | Skilled Nursing Facility | 0000000388 | TN | Yes |

## Other

- **Enumeration date:** 09/07/2007
- **Last updated:** 06/12/2008

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 7440605 | — | TN |