Provider Demographics
NPI:1386615920
Name:MISSIONARY BAPTIST FOUNDATION OF AMERICA, INC
Entity type:Organization
Organization Name:MISSIONARY BAPTIST FOUNDATION OF AMERICA, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:SARAH
Authorized Official - Middle Name:B
Authorized Official - Last Name:RICE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:806-747-3447
Mailing Address - Street 1:1212 13TH ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79401-3940
Mailing Address - Country:US
Mailing Address - Phone:806-747-3447
Mailing Address - Fax:806-747-1632
Practice Address - Street 1:3101 S MAIN ST
Practice Address - Street 2:
Practice Address - City:PERRYTON
Practice Address - State:TX
Practice Address - Zip Code:79070-5345
Practice Address - Country:US
Practice Address - Phone:806-435-5403
Practice Address - Fax:806-435-5055
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-31
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX114751313M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX675954Medicare Oscar/Certification