MEDICARE: MISSIONARY BAPTIST FOUNDATION OF AMERICA, INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	313M00000X	Nursing Facility/Intermediate Care Facility	114479	TX

General Provider Information

NPI Number	:	1184695033
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MISSIONARY BAPTIST FOUNDATION OF AMERICA, INC

Provider Business Mailing Address
First Line	:	1212 13TH ST
Second Line	:	SUITE 100
City	:	LUBBOCK
State	:	TX
Zip	:	79401-3940
Country	:	US
Telephone Number	:	806-747-3447
Fax Number	:	806-747-1632

Provider Business Practice Location Address
First Line	:	111 HOSPITAL DR
Second Line	:
City	:	JUNCTION
State	:	TX
Zip	:	76849-3020
Country	:	US
Telephone Number	:	325-446-3351
Fax Number	:	325-446-2167

Authorized Official
Title or Position	:	DIRECTOR OF OPERATIONS
Name	:	SARAH B RICE
Credential	:
Telephone Number	:	806-747-3447

Provider Enumeration Date	:	01/30/2006
Last Update Date	:	08/22/2020

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