Healthcare Provider Details

I. General information

NPI: 1306198023
Provider Name (Legal Business Name): ONLY BY FAITH INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/04/2012
Last Update Date: 10/04/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5700 W CHICAGO AVE
CHICAGO IL
60651-2621
US

IV. Provider business mailing address

5700 W CHICAGO AVE
CHICAGO IL
60651-2621
US

V. Phone/Fax

Practice location:
  • Phone: 773-287-7601
  • Fax:
Mailing address:
  • Phone: 773-287-7601
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code374T00000X
TaxonomyReligious Nonmedical Nursing Personnel
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number State

VIII. Authorized Official

Name: MISS DIANE DICKENS
Title or Position: PRESIDENT
Credential: RN
Phone: 773-287-7601