Healthcare Provider Details

I. General information

NPI: 1669828810
Provider Name (Legal Business Name): FAITH INDEPENDENCE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/06/2016
Last Update Date: 09/28/2021
Certification Date: 09/28/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

456 CANBY CIR
OCOEE FL
34761-8903
US

IV. Provider business mailing address

PO BOX 1533
WINDERMERE FL
34786-1533
US

V. Phone/Fax

Practice location:
  • Phone: 407-309-0481
  • Fax:
Mailing address:
  • Phone: 321-278-5824
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: LUE JIMMIE FILLICIA JOHNSON
Title or Position: OWNER
Credential:
Phone: 321-278-5824