Provider Demographics
NPI:1013384650
Name:CHURCH PARISH NURSE MINISTRIES
Entity Type:Organization
Organization Name:CHURCH PARISH NURSE MINISTRIES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:FANNIE
Authorized Official - Middle Name:M
Authorized Official - Last Name:HUDSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:386-290-2216
Mailing Address - Street 1:1376 TURNBULL BAY RD
Mailing Address - Street 2:SUITE 403
Mailing Address - City:NEW SMYRNA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32168-6076
Mailing Address - Country:US
Mailing Address - Phone:386-290-2216
Mailing Address - Fax:386-427-6270
Practice Address - Street 1:1376 TURNBULL BAY RD
Practice Address - Street 2:SUITE 403
Practice Address - City:NEW SMYRNA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32168-6076
Practice Address - Country:US
Practice Address - Phone:386-290-2216
Practice Address - Fax:386-427-6270
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-31
Last Update Date:2015-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL251B00000X, 251V00000X, 171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Single Specialty
Yes251B00000XAgenciesCase Management
No251V00000XAgenciesVoluntary or Charitable
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL011149800Medicaid