MEDICARE: FAITH BRIDGE HOME CARE

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	253Z00000X	In Home Supportive Care Agency

General Provider Information

NPI Number	:	1376152058
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FAITH BRIDGE HOME CARE

Provider Business Mailing Address
First Line	:	PO BOX 2621
Second Line	:
City	:	LEAGUE CITY
State	:	TX
Zip	:	77574-2621
Country	:	US
Telephone Number	:	832-425-6163
Fax Number	:

Provider Business Practice Location Address
First Line	:	1750 E LEAGUE CITY PKWY APT 118
Second Line	:
City	:	LEAGUE CITY
State	:	TX
Zip	:	77573-2691
Country	:	US
Telephone Number	:	713-476-2756
Fax Number	:

Authorized Official
Title or Position	:	HUMAN RECOURSES
Name	:	MICHAEL GERARD MOSES
Credential	:
Telephone Number	:	713-476-2756

Provider Enumeration Date	:	07/28/2020
Last Update Date	:	07/28/2020

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