1669546321 NPI number — THE CHRISTIAN & MISSIONARY ALLIANCE FOUNDATION INC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1669546321 NPI number — THE CHRISTIAN & MISSIONARY ALLIANCE FOUNDATION INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
THE CHRISTIAN & MISSIONARY ALLIANCE FOUNDATION INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1669546321
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/29/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
15000 SHELL POINT BLVD
Provider Second Line Business Mailing Address:
SUITE#100
Provider Business Mailing Address City Name:
FORT MYERS
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33908-1637
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
239-454-2146
Provider Business Mailing Address Fax Number:
239-454-2111

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
13880 SHELL POINT PLZ STE 200
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FORT MYERS
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33908-3504
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
239-454-2041
Provider Business Practice Location Address Fax Number:
239-454-2224
Provider Enumeration Date:
11/17/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
VASSAR
Authorized Official First Name:
TASHA
Authorized Official Middle Name:
MARIE
Authorized Official Title or Position:
MEDICAL BILLING MANAGER
Authorized Official Telephone Number:
239-433-7937

Provider Taxonomy Codes

  • Taxonomy code: 314000000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 022920200 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: ========= . This is a "TAX ID# (EIN)" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".