1356981047 NPI number — FAITH AND FAMILY HOME CARE LLC

Table of content: MICHAELE ROSE AGUIRRE RN (NPI 1699287730)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1356981047 NPI number — FAITH AND FAMILY HOME CARE LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FAITH AND FAMILY 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:
1356981047
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/13/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4160 LOGAN DR UNIT 52
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LOGANVILLE
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30052-9500
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
470-622-3962
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3339 GARDENSIDE WALK
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LOGANVILLE
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30052-7905
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
786-376-1360
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/09/2020

Additional Information

Authorized Official

Authorized Official Last Name:
RICHARDS
Authorized Official First Name:
VIANA
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
470-622-3962

Provider Taxonomy Codes

  • Taxonomy code: 374U00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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