Apple Valley Christian Centers

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

555476 Issued in CA

Legal business name

APPLE VALLEY CHRISTIAN CENTERS

Doing business as

Apple Valley Christian Care Center

Practice address

11959 Apple Valley Road
Apple Valley, CA 92308-7507

Phone

(760) 240-5051

Fax

(760) 240-8150

NPI assigned

Jan 30, 2006

Last updated

Jan 25, 2012By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Charles Mack

Title

Ceo

Phone

(949) 208-3399

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Apple Valley Christian Care Center Doing business as

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1138579200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1327449600000",
    "number": "1215908090",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11959 APPLE VALLEY ROAD",
            "city": "APPLE VALLEY",
            "state": "CA",
            "postal_code": "923087507",
            "telephone_number": "760-240-5051",
            "fax_number": "760-240-8150"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11959 APPLE VALLEY ROAD",
            "city": "APPLE VALLEY",
            "state": "CA",
            "postal_code": "923087507",
            "telephone_number": "760-240-5051",
            "fax_number": "760-240-8150"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "APPLE VALLEY CHRISTIAN CENTERS",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-01-30",
        "last_updated": "2012-01-25",
        "status": "A",
        "authorized_official_last_name": "MACK",
        "authorized_official_first_name": "CHARLES",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "949-208-3399",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "CA",
            "license": "555476",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "LTC55476F",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Apple Valley Christian Care Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Skilled Nursing Facility in Apple Valley, CA
• Providers in Apple Valley, CA by specialty
• Skilled Nursing Facility in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 25, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.