Healthcare Provider Details

I. General information

NPI: 1265607527
Provider Name (Legal Business Name): FAITH & GRACE INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/28/2008
Last Update Date: 04/28/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

44134 CAMELLIA ST
LANCASTER CA
93535
US

IV. Provider business mailing address

44134 CAMELLIA ST
LANCASTER CA
93535
US

V. Phone/Fax

Practice location:
  • Phone: 661-946-3161
  • Fax:
Mailing address:
  • Phone: 661-946-3161
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332BP3500X
TaxonomyParenteral & Enteral Nutrition Supplies (DME)
License Number
License Number State

VIII. Authorized Official

Name: MS. LA JUETA PAULK
Title or Position: VICE PRESIDENT/CFO
Credential:
Phone: 661-946-3161