1215690862 NPI number — CHRISTIAN FAITH HOME CARE

Table of content: (NPI 1215690862)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1215690862 NPI number — CHRISTIAN FAITH HOME CARE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CHRISTIAN FAITH HOME CARE
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:
CHRISTIAN FAITH HOME CARE
Provider Other Organization Name Type Code:
4
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:
1215690862
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/12/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 53281
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FAYETTEVILLE
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28305-3281
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
910-777-9402
Provider Business Mailing Address Fax Number:
910-809-2327

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4542 RAEFORD RD STE A1
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FAYETTEVILLE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28304-3203
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
910-777-9402
Provider Business Practice Location Address Fax Number:
910-809-2327
Provider Enumeration Date:
10/20/2021

Additional Information

Authorized Official

Authorized Official Last Name:
KEITH
Authorized Official First Name:
SHAZADA
Authorized Official Middle Name:
Authorized Official Title or Position:
DIRECTOR/OWNER
Authorized Official Telephone Number:
910-777-9402

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 253Z00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 347C00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: HC6272 . This is a "DIVISION OF HEALTH SERVICE REGULATION" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".




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