1649449091 NPI number — FAITH HOME, INC.

Table of content: (NPI 1649449091)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1649449091 NPI number — FAITH HOME, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FAITH HOME, INC.
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:
6
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:
1649449091
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/07/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2501 DONLORA DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GREENSBORO
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27407-6015
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
336-854-1718
Provider Business Mailing Address Fax Number:
336-854-1718

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
808 MYSTIC DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GREENSBORO
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27406-5726
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
336-856-0671
Provider Business Practice Location Address Fax Number:
336-856-0671
Provider Enumeration Date:
02/29/2008

Additional Information

Authorized Official

Authorized Official Last Name:
STURDIVANT
Authorized Official First Name:
LEON
Authorized Official Middle Name:
HARLIE
Authorized Official Title or Position:
OWNER / DIRECTOR
Authorized Official Telephone Number:
336-854-1718

Provider Taxonomy Codes

  • Taxonomy code: 322D00000X , with the licence number:  MHL041732 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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