Provider Demographics
NPI:1497301303
Name:M&A DISABLE VETERANS ASSISTANT LIVING HOME & MINISTRY, INC
Entity Type:Organization
Organization Name:M&A DISABLE VETERANS ASSISTANT LIVING HOME & MINISTRY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER /DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:CLERGY, CHAPLAIN
Authorized Official - Phone:772-200-0436
Mailing Address - Street 1:1850 SW MACKENZIE ST
Mailing Address - Street 2:
Mailing Address - City:PORT SAINT LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34953-1329
Mailing Address - Country:US
Mailing Address - Phone:772-200-0436
Mailing Address - Fax:866-270-2817
Practice Address - Street 1:1850 SW MACKENZIE ST
Practice Address - Street 2:
Practice Address - City:PORT SAINT LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34953-1329
Practice Address - Country:US
Practice Address - Phone:772-200-0436
Practice Address - Fax:866-270-2817
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-15
Last Update Date:2019-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoralGroup - Single Specialty