Healthcare Provider Details

I. General information

NPI: 1013384650
Provider Name (Legal Business Name): CHURCH PARISH NURSE MINISTRIES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/31/2015
Last Update Date: 11/17/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1376 TURNBULL BAY RD SUITE 403
NEW SMYRNA BEACH FL
32168-6076
US

IV. Provider business mailing address

1376 TURNBULL BAY RD SUITE 403
NEW SMYRNA BEACH FL
32168-6076
US

V. Phone/Fax

Practice location:
  • Phone: 386-290-2216
  • Fax: 386-427-6270
Mailing address:
  • Phone: 386-290-2216
  • Fax: 386-427-6270

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code251V00000X
TaxonomyVoluntary or Charitable Agency
License Number
License Number StateFL

VIII. Authorized Official

Name: MRS. FANNIE M HUDSON
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 386-290-2216