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Organization
CHRISTIAN CARE CENTER OF BOLIVAR LLC
Active
Organization
CHRISTIAN CARE CENTER OF BOLIVAR LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. LISA M CAWOOD GRAY (DELEGATED OFFICIAL, REGISTRATIONS O)
(423) 557-6116
Entity
Organization
Contact information
Practice address
10160 HIGHWAY 64W, BOLIVAR, TN 38008
(423) 975-5455
(423) 390-0743
Mailing address
2020 NORTHPARK DR STE 2D, JOHNSON CITY, TN 37604-3127
(423) 975-5455
(423) 390-0743
Taxonomy
Speciality
Code
Description
License number
State
313M00000X
Nursing Facility/Intermediate Care Facility
—
NULL
314000000X
Skilled Nursing Facility
Primary
—
NULL
Other
Enumeration date
03/31/2021
Last updated
01/31/2022
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