1205321791 NPI number — FAITH PRIMARY HOME CARE , LLC

Table of content: DR. KEITH EVAN FRASER M.D. (NPI 1881621266)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1205321791 NPI number — FAITH PRIMARY HOME CARE , LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FAITH PRIMARY HOME CARE , LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1205321791
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/27/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
813 EL GATO RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ALAMO
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78516-4124
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
956-451-7254
Provider Business Mailing Address Fax Number:
888-559-7871

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
813 EL GATO RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ALAMO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78516-4124
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
956-451-7254
Provider Business Practice Location Address Fax Number:
888-559-7871
Provider Enumeration Date:
06/27/2018

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
SANDOVAL
Authorized Official First Name:
LYDIA
Authorized Official Middle Name:
D
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
956-451-7254

Provider Taxonomy Codes

  • Taxonomy code: 3747P1801X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)