Healthcare Provider Details

I. General information

NPI: 1346445707
Provider Name (Legal Business Name): LLC FAITH CARING HOME HEALTH SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/17/2007
Last Update Date: 07/13/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3617 RIDGE BROOK TRL
DULUTH GA
30096-6895
US

IV. Provider business mailing address

3617 RIDGE BROOK TRL
DULUTH GA
30096-6895
US

V. Phone/Fax

Practice location:
  • Phone: 678-768-4797
  • Fax:
Mailing address:
  • Phone: 678-768-4797
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code311ZA0620X
TaxonomyAdult Care Home Facility
License Number
License Number State

VIII. Authorized Official

Name: RENEE MARIE DOUYON
Title or Position: ADMINISTRATOR, CHIEF OPERATOR
Credential:
Phone: 678-768-4797