MEDICARE: TAKEN BY FAITH LLC

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	251E00000X	Home Health Agency

General Provider Information

NPI Number	:	1376250969
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TAKEN BY FAITH LLC

Provider Business Mailing Address
First Line	:	3930 S OLD HIGHWAY 94 STE 105
Second Line	:
City	:	SAINT CHARLES
State	:	MO
Zip	:	63304-2836
Country	:	US
Telephone Number	:	636-244-2242
Fax Number	:

Provider Business Practice Location Address
First Line	:	3930 S OLD HIGHWAY 94 STE 105
Second Line	:
City	:	SAINT CHARLES
State	:	MO
Zip	:	63304-2836
Country	:	US
Telephone Number	:	636-244-2242
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	CALLIE DABNEY
Credential	:
Telephone Number	:	314-850-8045

Provider Enumeration Date	:	11/02/2022
Last Update Date	:	11/02/2022

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Directions to “TAKEN BY FAITH LLC ” Practice Location

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