MEDICARE: FAITH HOME FOR GIRLS 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	251C00000X	Developmentally Disabled Services Day Training Agency	NO LICENSE REQUIREDE	GA
2	251B00000X	Case Management Agency

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1255672937
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FAITH HOME FOR GIRLS INC

Provider Business Mailing Address
First Line	:	PO BOX 215
Second Line	:
City	:	COLUMBUS
State	:	GA
Zip	:	31902-0215
Country	:	US
Telephone Number	:	706-653-0828
Fax Number	:	706-321-1272

Provider Business Practice Location Address
First Line	:	1228 24TH ST
Second Line	:
City	:	COLUMBUS
State	:	GA
Zip	:	31901-1376
Country	:	US
Telephone Number	:	706-653-0828
Fax Number	:	706-321-1272

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MS. WYLEE S TOMS
Credential	:	DDP
Telephone Number	:	706-653-0828

Provider Enumeration Date	:	03/06/2013
Last Update Date	:	03/06/2013

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Directions to “FAITH HOME FOR GIRLS INC ” Practice Location

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