Provider Demographics
NPI:1720847726
Name:ARCHANGEL RAPHAEL MINISTRY CENTER INC
Entity type:Organization
Organization Name:ARCHANGEL RAPHAEL MINISTRY CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:
Authorized Official - Last Name:REZKALLA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:918-704-8881
Mailing Address - Street 1:19800 ALLAIRE LN
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33908-4828
Mailing Address - Country:US
Mailing Address - Phone:918-704-8881
Mailing Address - Fax:
Practice Address - Street 1:19800 ALLAIRE LN
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33908-4828
Practice Address - Country:US
Practice Address - Phone:918-704-8881
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-13
Last Update Date:2024-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities