MEDICARE: FAITH HOMECARE, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251G00000X	Community Based Hospice Care Agency	11736	AL

General Provider Information

NPI Number	:	1104882778
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FAITH HOMECARE, INC.

Provider Business Mailing Address
First Line	:	625 ALEX CITY SHOPPING CTR DR
Second Line	:
City	:	ALEXANDER CITY
State	:	AL
Zip	:	35010-2787
Country	:	US
Telephone Number	:	256-215-6006
Fax Number	:	256-215-3788

Provider Business Practice Location Address
First Line	:	60008 HIGHWAY 22
Second Line	:
City	:	ROANOKE
State	:	AL
Zip	:	36274-2419
Country	:	US
Telephone Number	:	334-863-6006
Fax Number	:	334-863-5312

Authorized Official
Title or Position	:	PRESIDENT / CEO
Name	:	MR. CHARLES WAYNE WILLARD SR.
Credential	:	RN
Telephone Number	:	256-215-6006

Provider Enumeration Date	:	04/24/2006
Last Update Date	:	08/22/2020

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Directions to “FAITH HOMECARE, INC. ” Practice Location

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