Healthcare Provider Details

I. General information

NPI: 1164029922
Provider Name (Legal Business Name): CHRIST IN THE VESSEL AGENCY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/05/2020
Last Update Date: 07/30/2024
Certification Date: 07/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6573 TRAVELER RD
WEST PALM BEACH FL
33411-6429
US

IV. Provider business mailing address

6573 TRAVELER RD
WEST PALM BEACH FL
33411-6429
US

V. Phone/Fax

Practice location:
  • Phone: 561-685-0914
  • Fax:
Mailing address:
  • Phone: 561-685-0914
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QD1600X
TaxonomyDevelopmental Disabilities Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MISS MELISSA ANN GEORGIANA SCOTT
Title or Position: CNA
Credential:
Phone: 561-685-0914