MEDICARE: THE CHRISTIAN & MISSIONARY ALLIANCE FOUNDATION INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	314000000X	Skilled Nursing Facility

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	=========	OTHER	FL	TAX ID# (EIN)

General Provider Information

NPI Number	:	1669546321
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THE CHRISTIAN & MISSIONARY ALLIANCE FOUNDATION INC

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

Provider Business Practice Location Address
First Line	:	13880 SHELL POINT PLZ STE 200
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33908-3504
Country	:	US
Telephone Number	:	239-454-2041
Fax Number	:	239-454-2224

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

Provider Enumeration Date	:	11/17/2006
Last Update Date	:	03/29/2022

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