Healthcare Provider Details

I. General information

NPI: 1669546321
Provider Name (Legal Business Name): THE CHRISTIAN & MISSIONARY ALLIANCE FOUNDATION INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/17/2006
Last Update Date: 03/29/2022
Certification Date: 03/29/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13880 SHELL POINT PLZ STE 200
FORT MYERS FL
33908-3504
US

IV. Provider business mailing address

15000 SHELL POINT BLVD SUITE#100
FORT MYERS FL
33908-1637
US

V. Phone/Fax

Practice location:
  • Phone: 239-454-2041
  • Fax: 239-454-2224
Mailing address:
  • Phone: 239-454-2146
  • Fax: 239-454-2111

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

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