Healthcare Provider Details

I. General information

NPI: 1346337896
Provider Name (Legal Business Name): FAITH ENTERPRISES, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/06/2006
Last Update Date: 02/26/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

545 W BEVERLY PL
TRACY CA
95376-3012
US

IV. Provider business mailing address

545 W BEVERLY PL
TRACY CA
95376-3012
US

V. Phone/Fax

Practice location:
  • Phone: 209-835-6034
  • Fax: 209-835-3339
Mailing address:
  • Phone: 209-835-6034
  • Fax: 209-835-3339

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number100000204
License Number StateCA

VIII. Authorized Official

Name: MR. R. DAVID DELISLE
Title or Position: ADMINISTRATOR
Credential: NHA
Phone: 209-835-6034