MEDICARE: FAITHFUL FAMILY CARE HOME

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	261QH0100X	Health Service Clinic/Center	FCL096033	NC

General Provider Information

NPI Number	:	1891977864
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FAITHFUL FAMILY CARE HOME

Provider Business Mailing Address
First Line	:	201 CLIFTON RIDGE DR
Second Line	:
City	:	PIKEVILLE
State	:	NC
Zip	:	27863-9518
Country	:	US
Telephone Number	:	919-222-9550
Fax Number	:	919-242-1258

Provider Business Practice Location Address
First Line	:	201 CLIFTON RIDGE DR
Second Line	:
City	:	PIKEVILLE
State	:	NC
Zip	:	27863-9518
Country	:	US
Telephone Number	:	919-222-9550
Fax Number	:	919-242-1258

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MRS. TINA FAYE SYKES
Credential	:	OWNER
Telephone Number	:	919-222-9550

Provider Enumeration Date	:	12/03/2007
Last Update Date	:	12/03/2007

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Directions to “FAITHFUL FAMILY CARE HOME ” Practice Location

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