Healthcare Provider Details

I. General information

NPI: 1679269740
Provider Name (Legal Business Name): FAITHFUL HEART CAREGIVERS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/12/2023
Last Update Date: 07/20/2023
Certification Date: 07/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

283 CRANES ROOST BLVD STE 111
ALTAMONTE SPRINGS FL
32701-3437
US

IV. Provider business mailing address

283 CRANES ROOST BLVD STE 111
ALTAMONTE SPRINGS FL
32701-3437
US

V. Phone/Fax

Practice location:
  • Phone: 321-754-9867
  • Fax: 321-999-7278
Mailing address:
  • Phone: 321-754-9867
  • Fax: 321-999-7278

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code372600000X
TaxonomyAdult Companion
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State

VIII. Authorized Official

Name: MRS. ALISHA A. GILLIAM
Title or Position: CHIEF EXECUTIVE OFFICER
Credential:
Phone: 321-754-9867