Healthcare Provider Details

I. General information

NPI: 1821160607
Provider Name (Legal Business Name): THE CHRISTIAN & MISSIONARY ALLIANCE FOUNDATION INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/15/2006
Last Update Date: 02/14/2022
Certification Date: 02/02/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13880 SHELL POINT PLAZA SUITE 110
FORT MYERS FL
33908
US

IV. Provider business mailing address

13880 SHELL POINT PLAZA SUITE 110
FORT MYERS FL
33908-3504
US

V. Phone/Fax

Practice location:
  • Phone: 239-466-1111
  • Fax: 239-454-2111
Mailing address:
  • Phone: 239-454-2146
  • Fax: 239-454-2111

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State

VIII. Authorized Official

Name: TASHA MARIE VASSAR
Title or Position: MEDICAL BILLING MANAGER
Credential:
Phone: 239-433-7937