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General NPI Number Information
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NPI Number | 1386073088
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Entity Type | Organization
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Legal Business Name | THE CHRISTIAN & MISSIONARY ALLIANCE FOUNDATION INC
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Dates
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Enumeration Date | 11/04/2013
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Last Update Date | 01/28/2020
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Provider Practice Location Address
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Address Line | 3600 KINGS CROWN CT
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City | FORT MYERS
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State | FL
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Zip | 33908-1648
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Country | US
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Telephone | 239-454-2179
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Fax | 239-454-2221
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Provider Business Mailing Address
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Address Line | 15000 SHELL POINT BLVD
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City | FORT MYERS
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State | FL
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Zip | 33908-1657
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Country | US
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Telephone | 239-454-2175
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Fax | 239-454-2221
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Authorized Official
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Title or Position | DIRECTOR OF ASSISTED LIVING
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Name | MRS. RITA MARIE SOUTHERN
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Credential |
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Telephone | 239-454-2179
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number | AL6012
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License Number State | FL
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