Organization
CHRISTIAN CARE CENTER OF KUTTAWA, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. LISA M. CAWOOD-GRAY (RISK CONSULTANT)
(423) 975-5455
Entity
Organization
Contact information
Practice address
1253 LAKE BARKLEY DRIVE, KUTTAWA, KY 42055-6124
(270) 388-2291
(270) 388-0948
Mailing address
2020 NORTHPARK, SUITE 2D, JOHNSON CITY, TN 37604-3127
(423) 975-5455
(423) 975-5405
Taxonomy
Speciality
Code
Description
License number
State
313M00000X
Nursing Facility/Intermediate Care Facility
100300
KY
314000000X
Skilled Nursing Facility
Primary
100300
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7100070570
—
KY
Enumeration date
04/02/2009
Last updated
10/14/2010
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