1346247434 NPI number — BEYONDFAITH HOMECARE & REHAB, LLC

Table of content: (NPI 1346247434)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1346247434 NPI number — BEYONDFAITH HOMECARE & REHAB, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BEYONDFAITH HOMECARE & REHAB, 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:
BEYONDFAITH HOMECARE & REHAB OF WICHITA FALLS
Provider Other Organization Name Type Code:
3
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:
1346247434
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/06/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5601 EXECUTIVE DR STE 250
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
IRVING
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75038-2508
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
972-677-3499
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6410 98TH STREET
Provider Second Line Business Practice Location Address:
STE 200
Provider Business Practice Location Address City Name:
LUBBOCK
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
79424
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
806-798-5683
Provider Business Practice Location Address Fax Number:
806-798-2443
Provider Enumeration Date:
07/05/2005

Additional Information

Authorized Official

Authorized Official Last Name:
VOGEL
Authorized Official First Name:
JILL
Authorized Official Middle Name:
Authorized Official Title or Position:
GENERAL COUNSEL
Authorized Official Telephone Number:
210-283-6243

Provider Taxonomy Codes

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

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

  • Identifier: 162453801 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 162453803 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 45D1017319 . This is a "CLIA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 162453802 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




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