Provider Demographics
NPI:1386073088
Name:THE CHRISTIAN & MISSIONARY ALLIANCE FOUNDATION INC
Entity type:Organization
Organization Name:THE CHRISTIAN & MISSIONARY ALLIANCE FOUNDATION INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF ASSISTED LIVING
Authorized Official - Prefix:MRS
Authorized Official - First Name:RITA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:SOUTHERN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:239-454-2179
Mailing Address - Street 1:15000 SHELL POINT BLVD
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33908-1657
Mailing Address - Country:US
Mailing Address - Phone:239-454-2175
Mailing Address - Fax:239-454-2221
Practice Address - Street 1:3600 KINGS CROWN CT
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33908-1648
Practice Address - Country:US
Practice Address - Phone:239-454-2179
Practice Address - Fax:239-454-2221
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-04
Last Update Date:2020-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL6012310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility