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General NPI Number Information
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NPI Number | 1386615920
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Entity Type | Organization
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Legal Business Name | MISSIONARY BAPTIST FOUNDATION OF AMERICA, INC
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Dates
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Enumeration Date | 01/31/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 3101 S MAIN ST
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City | PERRYTON
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State | TX
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Zip | 79070-5345
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Country | US
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Telephone | 806-435-5403
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Fax | 806-435-5055
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Provider Business Mailing Address
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Address Line | 1212 13TH ST SUITE 100
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City | LUBBOCK
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State | TX
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Zip | 79401-3940
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Country | US
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Telephone | 806-747-3447
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Fax | 806-747-1632
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Authorized Official
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Title or Position | DIRECTOR OF OPERATIONS
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Name | SARAH B RICE
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Credential |
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Telephone | 806-747-3447
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 313M00000X
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Taxonomy Name | Nursing Facility/Intermediate Care Facility
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License Number | 114751
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License Number State | TX
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