Healthcare Provider Details

I. General information

NPI: 1730150657
Provider Name (Legal Business Name): MISSIONARY BAPTIST FOUNDATION OF AMERICA, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/30/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1003 LOOP RD
ALPINE TX
79830-3229
US

IV. Provider business mailing address

1212 13TH ST SUITE 100
LUBBOCK TX
79401-3940
US

V. Phone/Fax

Practice location:
  • Phone: 432-837-3343
  • Fax: 806-837-7076
Mailing address:
  • Phone: 806-747-3447
  • Fax: 806-747-1632

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code313M00000X
TaxonomyNursing Facility/Intermediate Care Facility
License Number15657
License Number StateTX

VIII. Authorized Official

Name: SARAH B RICE
Title or Position: DIRECTOR OF OPERATIONS
Credential:
Phone: 806-747-3447