Provider Demographics
NPI:1164029922
Name:CHRIST IN THE VESSEL AGENCY LLC
Entity Type:Organization
Organization Name:CHRIST IN THE VESSEL AGENCY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CNA
Authorized Official - Prefix:MISS
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:ANN GEORGIANA
Authorized Official - Last Name:SCOTT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-702-1207
Mailing Address - Street 1:500 N CONGRESS AVE APT 85
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33401-2951
Mailing Address - Country:US
Mailing Address - Phone:954-702-1207
Mailing Address - Fax:
Practice Address - Street 1:500 N CONGRESS AVE APT 85
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33401-2951
Practice Address - Country:US
Practice Address - Phone:954-702-1207
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-05
Last Update Date:2020-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD1600XAmbulatory Health Care FacilitiesClinic/CenterDevelopmental Disabilities