# CHRISTIAN CARE CENTER OF BOLIVAR LLC

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

## Provider details

- **NPI number:** 1972181998
- **Authorized official:** MS. LISA M CAWOOD GRAY (DELEGATED OFFICIAL, REGISTRATIONS O)
- **Authorized official phone:** (423) 557-6116

## Contact information

- **Practice address:** 10160 HIGHWAY 64W, BOLIVAR, TN 38008
- **Practice address phone:** (423) 975-5455
- **Practice address fax:** (423) 390-0743
- **Mailing address:** 2020 NORTHPARK DR STE 2D, JOHNSON CITY, TN 37604-3127
- **Mailing address phone:** (423) 975-5455
- **Mailing address fax:** (423) 390-0743

## Taxonomy

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

## Other

- **Enumeration date:** 03/31/2021
- **Last updated:** 01/31/2022