Provider Demographics
NPI:1669546321
Name:THE CHRISTIAN & MISSIONARY ALLIANCE FOUNDATION INC
Entity type:Organization
Organization Name:THE CHRISTIAN & MISSIONARY ALLIANCE FOUNDATION INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
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 1:15000 SHELL POINT BLVD
Mailing Address - Street 2:SUITE#100
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33908-1637
Mailing Address - Country:US
Mailing Address - Phone:239-454-2146
Mailing Address - Fax:239-454-2111
Practice Address - Street 1:13880 SHELL POINT PLZ STE 200
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33908-3504
Practice Address - Country:US
Practice Address - Phone:239-454-2041
Practice Address - Fax:239-454-2224
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:THE CHRISTIAN AND MISSIONARY ALLIANCE FOUNDATION INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-11-17
Last Update Date:2022-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL022920200Medicaid
FL=========OtherTAX ID# (EIN)
FL105966Medicare PIN
FL=========OtherTAX ID# (EIN)