Healthcare Provider Details

I. General information

NPI: 1689829657
Provider Name (Legal Business Name): FAITH HOUSE ASSISTED LIVING FACILITLY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/18/2008
Last Update Date: 11/18/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

335 FOSTER CV
CHULUOTA FL
32766-8003
US

IV. Provider business mailing address

335 FOSTER CV
CHULUOTA FL
32766-8003
US

V. Phone/Fax

Practice location:
  • Phone: 407-366-9961
  • Fax:
Mailing address:
  • Phone: 407-366-9961
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License NumberAL10995
License Number StateFL

VIII. Authorized Official

Name: MRS. MARY DURAND
Title or Position: ADMINISTRATOR
Credential:
Phone: 407-366-9961