Healthcare Provider Details

I. General information

NPI: 1093396376
Provider Name (Legal Business Name): FAITH HEALTHCARE INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/18/2021
Last Update Date: 12/07/2023
Certification Date: 12/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5775 N HIGHWAY 27 STE 7
SCIENCE HILL KY
42553-9140
US

IV. Provider business mailing address

521 CRANE RD
SOMERSET KY
42501-9503
US

V. Phone/Fax

Practice location:
  • Phone: 606-416-1190
  • Fax:
Mailing address:
  • Phone: 66-425-5768
  • Fax: 606-425-5769

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: LOGAN ROY ANTLE
Title or Position: CEO
Credential:
Phone: 606-425-5768