Provider Demographics
NPI:1821160607
Name:THE CHRISTIAN & MISSIONARY ALLIANCE FOUNDATION INC
Entity Type:Organization
Organization Name:THE CHRISTIAN & MISSIONARY ALLIANCE FOUNDATION INC
Other - Org Name:SHELL POINT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEDICAL BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:TASHA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:VASSAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:239-433-7937
Mailing Address - Street 1:13880 SHELL POINT PLAZA
Mailing Address - Street 2:SUITE 110
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33908-3504
Mailing Address - Country:US
Mailing Address - Phone:239-454-2146
Mailing Address - Fax:239-454-2111
Practice Address - Street 1:13880 SHELL POINT PLAZA
Practice Address - Street 2:SUITE 110
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33908
Practice Address - Country:US
Practice Address - Phone:239-466-1111
Practice Address - Fax:239-454-2111
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:THE CHRISTIAN & MISSIONARY ALLIANCE FOUNDATION INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-11-15
Last Update Date:2022-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL39487Medicare PIN