Provider Demographics
NPI:1831532027
Name:CHURCH FAMILY ENTERPRISES LLC
Entity type:Organization
Organization Name:CHURCH FAMILY ENTERPRISES LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:CHURCH
Authorized Official - Suffix:
Authorized Official - Credentials:LMT
Authorized Official - Phone:561-241-6690
Mailing Address - Street 1:5030 CHAMPION BLVD STE D7
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33496-2497
Mailing Address - Country:US
Mailing Address - Phone:561-241-6690
Mailing Address - Fax:
Practice Address - Street 1:5030 CHAMPION BLVD STE D7
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33496-2497
Practice Address - Country:US
Practice Address - Phone:561-241-6690
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-08
Last Update Date:2013-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMM24970225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty