Provider Demographics
NPI:1053572628
Name:C3 CHRISTIAN ACADEMY LLC
Entity type:Organization
Organization Name:C3 CHRISTIAN ACADEMY LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PROGRAM ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:TRISHA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:817-899-2537
Mailing Address - Street 1:6609 BAKER BLVD
Mailing Address - Street 2:
Mailing Address - City:RICHLAND HILLS
Mailing Address - State:TX
Mailing Address - Zip Code:76118
Mailing Address - Country:US
Mailing Address - Phone:817-899-2537
Mailing Address - Fax:214-377-8543
Practice Address - Street 1:6609 BAKER BLVD
Practice Address - Street 2:
Practice Address - City:RICHLAND HILLS
Practice Address - State:TX
Practice Address - Zip Code:76118
Practice Address - Country:US
Practice Address - Phone:817-899-2537
Practice Address - Fax:214-377-8543
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-17
Last Update Date:2008-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385HR2060XRespite Care FacilityRespite CareRespite Care, Intellectual and/or Developmental Disabilities, Child