Healthcare Provider Details

I. General information

NPI: 1255672937
Provider Name (Legal Business Name): FAITH HOME FOR GIRLS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/06/2013
Last Update Date: 03/06/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1228 24TH ST
COLUMBUS GA
31901-1376
US

IV. Provider business mailing address

PO BOX 215
COLUMBUS GA
31902-0215
US

V. Phone/Fax

Practice location:
  • Phone: 706-653-0828
  • Fax: 706-321-1272
Mailing address:
  • Phone: 706-653-0828
  • Fax: 706-321-1272

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License NumberNO LICENSE REQUIREDE
License Number StateGA

VIII. Authorized Official

Name: MS. WYLEE S TOMS
Title or Position: ADMINISTRATOR
Credential: DDP
Phone: 706-653-0828